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| 2015-04-27 |
| Don't worry. This isn't happening in the US. Yet. That I know of. Doctors are being told to ask all patients over 75 if they will agree to a 'do not resuscitate' order. New NHS guidelines urge GPs to draw up end-of-life plans for over-75s, as well as younger patients suffering from cancer, dementia, heart disease or serious lung conditions. They are also being told to ask whether the patient wants doctors to try to resuscitate them if their health suddenly deteriorates. The NHS says the guidance will improve patients' end-of-life care, but medical professionals say it is 'blatantly wrong' and will frighten the elderly into thinking they are being 'written off'. In some surgeries, nurses are cold-calling patients over 75 or with long-term conditions and asking them over the phone if they have 'thought about resuscitation'. Other patients have spoken of the shock of going in for a routine check-up and being asked about resuscitation. The extraordinary new guidance has been brought in despite the outcry over the use of 'do not resuscitate' orders under the Liverpool Care Pathway (LCP). The discredited pathway was scrapped last year after the Mail revealed that doctors were placing 'DNR' notices on patients without their knowledge and depriving them of food and fluids. The guidelines -- which also recommend patients should be asked if they want to die at home -- have been drawn up by experts advising NHS England, the organisation which runs the health service. One expert last night said the guidance was 'the thin end of the wedge of assisted suicide'. Professor Patrick Pullicino, who spearheaded the campaign against the LCP, said: 'What is most blatantly wrong is trying to get someone to agree to a 'do not resuscitate' order before they are even sick. For somebody who is perfectly well, or has got a mild or not a serious illness, that would be totally out of place.' Roy Lilley, a health policy analyst and former NHS trust chairman, said: 'It will give some older people the impression that no-one wants to bother with them. It looks as though they're being told: 'You're old, how do you want to die because you're in the way'. 'It's a very clunky thing to do -- it's completely unnecessary.' Roger Goss, of Patient Concern, said: 'There will be some people who will be put out, disconcerted and think they are not going to get the best available care. They might think this is a way of saving money for the NHS. Other patients will be prepared to talk about it and think it sensible.' A 'do not resuscitate' order is meant to stop a patient suffering unnecessarily where their lives are likely to be extended for only a short period of time. Resuscitation can be traumatic and cause broken ribs or damage to organs, including the spleen. Doctors estimate that only 10 to 15 per cent of patients are brought back to life and some suffer permanent brain damage. But asking patients to make such a decision when they may have many years to live will prompt concerns that the NHS is writing them off. In some parts of England, practice nurses have been instructed to cold-call patients and fill out an advance care plan for them over the phone. Ruth Nicholls, a palliative care nurse in the South East, told how her brother-in-law, who has a heart condition, was contacted immediately after he had a hospital appointment. In an interview with Nursing Times, she said: 'He came back from an outpatient appointment having not had very good news and later that afternoon got a phone call from one of the practice nurses at his GP surgery. 'She said: 'Hello, we're ringing all our patients with chronic conditions to see how you are and whether you have thought about resuscitation.' 'This conversation was absolutely out of nowhere. My brother-in-law was shocked and my sister was distraught.' She also said an elderly patient was asked about resuscitation by a district nurse he had never met during a routine visit. 'One of the first questions he was asked was whether he wanted to be resuscitated,' she said. 'People are being left in great distress.' The controversial Liverpool Care Pathway was phased out last year following harrowing reports that patients were being left so dehydrated they were left to suck on wet sponges given by relatives because nurses had banned water. |
| Posted by:gorb |
| #6 OOOOOOOOOOO, you just know that GWCC intensifies towards Year 2050, + the US-World + mighty OWG-NWO = SPACE GOVT-ORDER = SPACE COMMAND starts building Spaceships + "Off-Earth Bases", "SOLYENT GREEN" WILL BE THERE! |
| Posted by: JosephMendiola 2015-04-27 21:27 |
| #5 Useful thoughts. Thanks, Steve. |
| Posted by: KBK 2015-04-27 19:02 |
| #4 When members of Congress are elected to office, they each need to sign a "do not resuscitate" order. Only then will we negotiate. |
| Posted by: Alaska Paul 2015-04-27 17:33 |
| #3 Further, death has 100% penetrance: we're all going to die of something Yep, Death is a pie chart. Move one radii to make one area smaller only makes another area larger. Oh, and that's area special interest group scream louder for more research funding. |
| Posted by: Procopius2k 2015-04-27 13:46 |
| #2 Advance directives as a part of a living will are not new. Most people discuss such things with their attorney prior to the need. I was in a conversation with my physician about Obamacare and it's impact on healthcare the other day. He mentioned a patient he was treating for cancer. He said he could provide curative treatment for the patient but the insurance company would only cover palliative care, i.e. care which would make his quality of life better for awhile but not cure the disease. The point is that in the U.S., insurance companies, in fact, often make the end-of-life decisions for you. |
| Posted by: JohnQC 2015-04-27 13:36 |
| #1 As a lung physician, I've dealt extensively with DNR orders. It is very true that an out-of-hospital arrest is seldomly resuscitated and restored to former health status. Ditto for the very large majority of in-hospital arrests, even witnessed ones. Further, death has 100% penetrance: we're all going to die of something. It's a fair question to discuss with an older patient, or any patient with a chronic, debilitating illness with a downward course, just how much they want done and how heroic they want the medical system to be. Most patients are clear-eyed, realistic and get it. Some need a little more time. With that said, what NHS is doing is indeed trying to intimidate older patients simply to save money. If they'd like to prove otherwise, the high level managers could start by posting on-line their own DNR orders. Cold-calling is inappropriate: DNR, living will, and heroic measures should be discussed at a time and setting conducive to answering questions, comforting people in a time of a potentially upsetting conversation, and ensuring that there is sufficient time to answer all questions. I do some work with ALS patients, and my initial consultation with them is 90 minutes precisely for this reason. I'd look NHS in the eye and remind them that I wear a white coat, not a black robe. |
| Posted by: Steve White 2015-04-27 12:34 |