Doctors forced to 'degrade' dying patients; Resuscitation 'chaos'

A LEADING consultant has warned that doctors must have the power to label hospital patients "not for resuscitation without their consent.

Professor Hugh Tunstall-Pedoe, director of the cardiovascular epidemiology unit in Dundee's Ninewells Hospital, said patients were being subjected to degrading treatment through attempts to revive them after their heart stopped.

In comments that are sure to re-ignite debate over resuscitation, he accused the civil rights lobby of "railroading" doctors into a position where they feel they must administer cardiopulmonary resuscitation (CPR) or face litigation.

The prevailing populist culture, he said, had led to "chaos" in doctors' and health boards' understanding of what is appropriate treatment for patients.

"Doctors and nurses are under pressure to do things they wouldn't want for themselves or relatives, but they do it as a form of protection," he said. "[CPR], which should be selective, is being railroaded into something that should be used universally."

Guidelines issued by the British Medical Association in 2001 emphasised more consultation with patients and relatives, but retained a doctor's right not to administer treatment they deemed inappropriate. It followed a string of reports about patients who discovered they had "do not resuscitate" (DNR) orders written in their medical notes after being released from hospital.

However, instead of resolving confusion, doctors say the current political climate has created a situation where they are at risk even if they act in patients' interests. The Scottish medica ombudsman was asked to investigate the recent case of a cancer patient whose husband complained after he found a DNR order in her notes. Although the patient was released from hospital, she died at home a week later.

"Nobody complains if you bounce on the chest of someone who's died, even though it detracts from the dignity of death," Tunstall- Pedoe said. "If they hear CPR wasn't attempted they may say you discriminated against them, even if you do it with the best intentions.

"If a patient is in a terminal condition you can't resolve, it is not sensible, practical or kind to submit them to CPR."

The Sunday Herald understands there is growing disquiet among medical professionals over the inadequacy of the guidelines. Later this year, the issue will come under the spotlight when a Scottish Executive-led seminar will give a platform for campaign groups to air their concerns about DNR orders.

At the conference, planned for the summer, the Disability Rights Commission Scotland (DRCS) will demand doctors stop using DNR orders to discriminate against disabled people. However, the view that doctors must be able to issue orders without consulting patients is gathering support.

Dr Neville Goodman, a consultant anaesthetist at Bristol's Southmead Hospital, said: "If we are forced to ask each patient when they come into the hospital to sign a form about whether they want to be revived or not we run the risk of distressing them. Some do not want to know all the options.

"It's frankly obscene for everyone to be resuscitated. Doctors must be able to decide when to resuscitate, not lawyers."

According to Tunstall-Pedoe, TV medical soaps are also fuelling the view that CPR should be used in all cases. Although programmes were found to show that 75% of patients survived cardiac arrest, the reality is that less than 10% survive. Given such poor levels of success, only around 20% of patients receive CPR at Ninewells Hospital.

However, pressure groups condemned the view that doctors should be able to issue an order not to resuscitate. Roger Goss, co-director of Patient Concern, said: "Doctors should never have the right to decide. They do not know what the patient's perception of what cruel and degrading is. They should not play God. What we are talking about is a patient's life and body, not the doctor's."

A DRCS spokeswoman said: "More information and support is needed for medical professionals to help develop good practice in this area."

Context

BMA guidelines in 2001 were supposed to simplify the procedure of when doctors can revive hospital patients. But with medics vilified for using DNR (do not resuscitate) orders, there is growing concern that patients are not being allowed to die with dignity.

Claims CPR should be used selectively have re-ignited the resuscitation debate Photograph: Getty

Copyright 2004 SMG Sunday Newspapers Ltd.
Provided by ProQuest Information and Learning Company. All rights Reserved.