Friday, October 21, 2011

Death by Secret Order or Euthanasia by the Backdoor

Do Not Resuscitate (DNR) orders have been around for a while. Everyone admitted to my service is questioned regarding their wishes pertaining to DNR. That is would they want cardiopulmonary resuscitation performed on them in the event their heart were to stop or they were to stop breathing. Many are unsure having never considered such a scenario and this line of discussion opens up an area of consideration for patients to think about even after discharge. Some however, are clear that they would want no extraordinary life sustaining procedures regardless of potential outcome. It all gets down to the ethical principal of a patients autonomy. That is, informed consent. Patients have the right to make decisions regarding their medical care even if I don't like them.

With this in mind, it comes as quite a shock to learn that physicians in England were routinely writing DNR orders on patients without any discussion, whatsoever, with either the patient or their families.

This is beyond obscene!

The orders – which record an advance decision that a patient's life should not be saved if their heart stops – are routinely being applied without the knowledge of the patient or their relatives.

On one ward, one-third of DNR orders were issued without consultation with the patient or their family, according to the NHS's own records. At another hospital, junior doctors freely admitted that the forms were filled out by medical teams without the involvement of patients or relatives.

Under medical guidelines, the orders should only be issued after senior staff have discussed the matter with the patient's family. A form, signed by two doctors, is then placed in the patient's notes to record what decision was taken.

The findings emerged in spot checks of 100 hospitals undertaken by the Care Quality Commission (CQC), an official watchdog, earlier this year.

A charity for the elderly said the disclosures were evidence of "euthanasia by the backdoor," with potentially-lethal notices being placed on the files of patients simply because they were old and frail.
In one case DNR paperwork had been twice placed in a patients chart by physicians in spite of her explicit wishes to remain a "full code". It is irrelevant that there was a diagnosis of terminal lung cancer or that she was only 63.

Patients with acute myocardial infarctions aren't protected either,

In 2009, heart attack victim Peter Clarke was left to die at Derby Hospitals Trust after clerical staff inserted a DNR form into his notes.

Although the document was blank, nursing staff making handover notes misinterpreted it, and said the widower, who had been admitted suffering heart disease and flu-like symptoms, should not be resuscitated if his condition worsened.

When he suffered a heart attack, nurses did not call doctors to revive him. An hour too late they realised the DNR order was blank.

Last year an inquest into his death found staff had been "routinely" placing the forms in medical records before they had been signed and witnessed. The trust stopped the policy, and said it was not aware other patients had been affected.

The dossier of cases was gathered by Action on Elder Abuse because it believes that the NHS inspectorate is uncovering widespread failings, yet doing little to protect elderly patients in immediate danger – and nothing to highlight the misuse of DNR notices.

Gary Fitzgerald, the charity's chief executive said: "We believe that there is a real danger here that we are seeing euthanasia by default and by the back door.

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