This disagreement has been publicly discussed for many years, and screams “communication failure” between hospital staff and patients, and their relatives – particularly their relatives. But also, sadly, between hospital workers and the president of the Royal College of GPs.
Resuscitation is not for patients to opt in or opt out, like breast enhancement or a facelift. It is the dramatic last stand in a provision of circulatory and respiratory support offered to some patients. Patients can choose to refuse any treatment at any time, but appreciation of medical limits increases confidence and trust.
Patients need to understand that when all definitive treatment for a disease has failed, and the circulation ceases, this is not the time to start treating the disease, because everything possible has already been done
About 50 years ago DNR (Do Not Resuscitate) labels were placed on some patients’ notes by doctors to stop the cardiac arrest team being called out for every death. The team, called to treat an unfamiliar patient, would have to read the notes in detail, by which time the treatment would be too late. This precaution allowed the nurses to avoid mistakes that would waste valuable staff time and energy, valuable blood and expensive disposable equipment and materials.
Patients need to understand that when all definitive treatment for a disease has failed, and the circulation ceases, this is not the time to start treating the disease, because everything possible has already been done. If it is known that the cause of death cannot be reversed, nothing more can be achieved. This should be the basis for any discussion, if discussion is sought.
There are a few circumstances in which it may be reversed, when the lethal blow was so sudden that earlier support could not be given, then it may be possible to help a patient whose heart has stopped; including coronary occlusion, electric shock, embolism, suffocation, drowning, haemorrhage, hypothermia, poisoning (including gas), severe head or chest injury and a few other recent insults.
Explaining to a patient that resuscitation is “not in your best interests” will not soothe a suspicious patient; it will make him very cross!
Dr CJF Potter