There is already much good practice around talking about end of life care. However, some clinicians are unwilling to raise the subject of resuscitation – fearing that patients with get upset or complain. Those clinicians who feel hesitant could usefully hear the quiet voices of patients and families who appreciate it when they can talk about resuscitation.
My wife recently died from pancreatic cancer. In the event she died quite quickly and at home.
My wife and I had both made living wills, but in any event our GP, when she first came to visit after my wife’s operation, made it quite clear that she had the option of a DNR [Do Not Resuscitate] note placed on her file for District nurses and, if necessary, ambulance crew. We were impressed and readily complied.
I do not want to be kept alive when the outcome will result in a less than reasonable life. All my family know of my decision.
When I was last admitted to [the local] General Hospital last year as an emergency, I was asked by the nurse admitting me whether I wanted resuscitating. To me this was very reassuring and therefore both the hospital and I knew where we stood on the matter.
She asked me for a copy of my Advance Directive which I have given to them.
‘John’ and ‘Sue’ are not real names. But these are real stories, and these are John and Sue’s real words.
The press has reported how bad it is, or can be, to be asked about resuscitation.(1) I do not want to diminish this at all — especially because because of the evidence that stand-alone DNACPR orders can lead to worse care.(2)
But the people who don’t have a problem with, who even actively welcome, discussions about resuscitation are less often heard from.
The discussions about resuscitation with John and Sue were rewarding for both the patients and, I feel sure, the medical staff.
And it’s not only John and Sue. The majority of calls to the Compassion in Dying Helpline are from people worried about being resuscitated against their wishes. Significant numbers of callers ask directly how to avoid attempted resuscitation, with other are worried that their wishes won’t be known.(3)
And they are right to be worried — unwanted CPR attempts continue to take place.(4)
Do we need to wait for a high profile complaint about an unwanted attempted resuscitation before more notice is taken of this?
1. Borland S. Over 75? Sign here if you’re ready for death: GPs to ask ALL older patients if they’ll agree to a ‘do not resuscitate’ order. The Daily Mail. 27 April 2015. http://www.dailymail.co.uk/news/article-3056621/Over-75-Sign-ready-death-GPs-ask-older-patients-ll-agree-not-resuscitate-order.html#ixzz3hwwuZVCZ Date accessed: 25 Sept 2016.
2. Relevant papers include: Fritz Z. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: Current practice and problems – and a possible solution’. SRCC seminar. June 2014 /de Decker L, Annweiler C, Launay C, et al. Do not resuscitate orders and aging: impact of multimorbidity on the decision-making process. J Nutr Health Aging 2014;18(3):330-5 /Richardson DK, Zive D, Daya M, et al. The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest. Resuscitation. 2013 Apr;84(4):483-7; / Fritz Z, Fuld J, Haydock S, et al. Interpretation and intent: a study of the (mis)understanding of DNAR orders in a teaching hospital. Resuscitation. 2010;81(9):1138-41 / Wenger NS, Pearson ML, Desmond KA, et al. Outcomes of patients with do-not-resuscitate orders. Toward an understanding of what do-not-resuscitate orders mean and how they affect patients. Arch Intern Med 1995;155(19):2063-8.
3. Table 8 page 35 Perkins GD, Griffiths F, Slowther A-M, George R, Fritz Z, Satherley P, et al. Do-not-attempt- cardiopulmonary-resuscitation decisions: an evidence synthesis. Health Serv Deliv Res 2016;4(11)
4. Anonymous. Walk Away Ending: Why I chose not to complain about my mother’s NHS care. 7 Jan 2014. https://grumblingappendix.wordpress.com/2014/01/07/walk-away-ending-why-i-chose-not-to-complain-about-my-mothers-nhs-care/ Date accessed: 25 September 2016 / See also: page 61 in: A report by the National Confidential Enquiry into Patient Outcome and Death. Time to Intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. 2012. http://www.ncepod.org.uk/2012report1/downloads/CAP_fullreport.pdf Date accessed: 25 September 2016