1. Management
Page 5
Editor's Word
End of life as we know it
Just when is the right time to address a 'do not attempt
cardio-pulmonary resuscitation' order?
insensitivity, poor communication and poor
judgement by clinicians. I don’t approve of
unthinking, blanket application of box ticking
policies linked to performance incentives with no
regard to the individuals they affect…
‘Do not resuscitate orders discussed fully and
sensitively with patients or their carers can also
prevent an undignified and over-medicalised end
to older people’s lives.’
Life support
DNRs are not known as high intensity
interventions for nothing – although designed
to bring a person back from the edge of death,
they can leave in their wake many other medical
complications that impact negatively on the
quality of life thereafter. DNRs also remove the
odious onus upon family members to turn off
the life support machine on behalf of an ailing
parent who has suffered a long illness and has
not made any end-of-life decisions. Therefore,
for all the reasons above, as I nudge 50, I will
be addressing my own wishes and sharing them
with relevant parties whilst still blessed with my
health. End-of-life plans do need to be discussed
(and not just with the long-term sick and over
75s) to ensure dignity and to meet evryone's
expectations. Like a good joke, ironcially, the
success of such a serious discussion lies in the
timing – and its delivery.
D
NACPR is a much-debated topic. Articles
on the subject range from emotive
headline-grabbing coverage to long and
reasoned blogs that address the very
real scenario of what can often be an aggressive
attempt to prolong a life – and not always with the
positive outcome much hoped for. Most patients
receiving end-of-life care wish to meet a peaceful
end, I am sure, but what is appropriate regards
timing – during a GP check-up when their health is
not severely compromised and there’s already an
on-going discussion about palliative care? Or, is
it best approached in times of a crisis by hospital
staff already time poor and juggling the many
needs of many patients in A&E.
Kneejerk
Dr David Oliver recently penned a piece about
the Daily Mail’s typically kneejerk reaction to the
drawing up end-of-life care plans for people over
75. In his online article, Fear mongering headlines
can harm end of life care, he points out that: ‘I
and many other clinicians try every day to help
patients with incurable conditions and their families
to exercise some choice and control, to try to
die in the place of their choosing – generally, not
in a hospital if they can help it. Good advance
planning can enhance people’s chances of dying
in their own homes or care homes or making it
to a hospice.' He adds: ‘I don’t seek to defend Golden rules
@JulesBiscuit
@ThePMmag