Hazel McHaffie

National Confidential Enquiry intoPatient Outcome and Death Review

Do Not Resuscitate

You’d have to be an ostrich on an uninhabited desert island not to be aware that this week marked the Diamond Jubilee of the Queen’s accession to the throne. Whatever you think of the institution of monarchy, I’m sure you would agree she is a truly remarkable woman. Well into her eighties she shows a stamina and strength of character and purpose few of her age group could or would attempt to emulate. Her timetables are punishing. Her application to the duties and responsibilities of her position, unflagging. She seems to make few concessions to the years. No other 86 year old of my acquaintance would stand for hours on a barge on a cold wet day and stay up all hours listening to deafening music and smile and chat relentlessly to perfect strangers hour after hour and … well, you get my drift.

But she is human. She is elderly. A jolt went through the nation recently when her husband, Prince Philip, aged 90, showed his frailty, actually missing royal Christmas festivities because he required cardiac surgery. Serious stuff. And now this week he’s in hospital missing the Diamond Jubilee celebrations because of a bladder infection. Not of itself serious, but obviously someone somewhere has concerns.

It made me think … What if he or the Queen suffered a sudden medical emergency necessitating resuscitation? What would be the morally right course of action? What would they themselves choose? Would their preferences prevail?

This week we’ve learned that an alarming number of elderly people are being resuscitated against their wishes. Hey, never mind the royals, I have a vested interest in this. A few years ago I wrote my own advanced directive spelling out the circumstances in which I wish to be allowed to die with dignity. No dragging me back for a life of pain and suffering and degradation, thank you very much. I had the said declaration medically witnessed. I filed it carefully and clearly. I had deep and meaningful discussion with my nearest and dearest, so that they are fully informed of my intentions and preferences, and committed to ensuring they are respected.

Imagine if some enthusiastic (or maybe insecure) junior doctor somewhere decided he would overrule all that careful thinking and discussion and do his own thing. Boy, would I be mad! What gives him the right to know better than I what is best for me?

So the National Confidential Enquiry into Patient Outcome and Death Review, looking into the care given to 585 acutely-ill patients (average age 77 years) who ended up having a cardiac arrest, made sobering reading this week. The watchdog concluded that ‘cardiopulmonary resuscitation (CPR) had wrongly become the default setting.‘ They recommended that sensible assessment as to the necessity for resuscitation should become standard. Well, hurrah. Sensible indeed.

In the wake of these revelations, naturally lots of people have stories to tell of misapplied zeal, or woeful lack of monitoring or commonsense. And of course, their accounts also remind us that experience and preferences vary greatly.

My fatherMy own father had a heart attack very publicly on a bus when aged 75, on his way to visit a beautiful garden. Only minutes into the journey he observed that it was going to be a lovely day and then slumped against my mother, dead, without fuss or drama. For him, perfect. But my mother had to stand on one side while he was pummelled vigorously. In vain. The paramedics had no choice but to attempt to revive him, they said.

My motherIn her case, as soon as she went into residential care, we made it absolutely clear to all relevant parties that she did not want heroic efforts to resuscitate her, with appropriate signed-and-sealed documentation in place. The day she put her name to her advanced declaration in the presence of two independent witnesses, the family were going to a funeral and the room was full of black-clad sombre people, which gave it all an unintended but rather theatrical ambience! When her last illness took hold, she was past acting autonomously, but we were able to reinforce that considered and sustained choice with the caring team. She died with peace and dignity aged 90, unmolested.I devoutly hope that this latest public report will spark sensible discussion and lead to more sensitive and appropriate practice. We only die once.

And of course I wish His Highness a speedy and complete recovery.

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