Long life

The over-75s are being asked if they would like to sign their own death warrants

The NHS is cold calling the elderly about do not attempt resuscitation orders

9 May 2015

9:00 AM

9 May 2015

9:00 AM

It’s more than four months now since my 75th birthday, but I’m still waiting for a ‘cold call’ from the NHS to ask if I have ‘thought about resuscitation’. This is what the Daily Mail warned me last week that anyone over 75 might now receive. As it so happens, I do quite often think about resuscitation, though only in the sense that I would like to be somehow revived when I fall asleep at my desk. But the Mail was talking about something different: NHS guidelines by which doctors are required to ask their elderly patients if they would like to be resuscitated when they suffered a heart attack or a stroke or other such life-threatening events. The paper was spluttering with indignation over this ‘extraordinary new guidance’, quoting ‘medical professionals’ as saying that it was ‘blatantly wrong’ and would frighten the elderly into thinking they were being ‘written off’. It mentioned particularly the shock felt by patients, visiting their medical centre for a routine check-up, at being suddenly confronted with a question about whether or not they would like to be left to die.

All this was emblazoned on the Mail’s front page as something new, but it is now almost a year since I went with my brother John to just such a routine check-up and saw him undergo the same experience. John, who died on New Year’s Eve, was already aged 87 and suffering from a motley collection of ailments that included Parkinson’s, diabetes and chronic obstructive pulmonary disease. His very nice and sympathetic doctor explained to him that the NHS had recently introduced a new service for people whom it delicately described as ‘more at risk of unplanned hospital admissions’ than others. As one such, he was told he would be assigned a named GP to take special care of him and must fill in a form giving details of his ailments, medication, carers and so on, so that ambulancemen would be fully briefed when they turned up in an emergency.

So far, so good. But then he was asked whether he would like, added to the form, a ‘do not attempt resuscitation’ order. He looked bewildered. Although much debilitated, he was in fine mental condition and possessed of a very strong will to live. He would religiously take some 30 pills a day and go for stumbling little walks to limit the depredations of his various ailments. Not long beforehand, he had been to see a Parkinsonian specialist in hospital and asked her if she thought his Parkinson’s might shorten his life. He was much displeased when she told him (in so many words) that while it was difficult to say, it seemed that he had lived rather a long time already.

So he asked his kindly GP why anybody could possibly wish not to be resuscitated if he had had a heart attack? The doctor’s answer was depressingly frank. While resuscitation had a 50–50 chance of success with young people, he said, its record with old people was abysmal. If your heart stopped when you were old, you were almost bound to die in any event. But if somebody jumped on you to get it going again, you might not die peacefully but in agony — possibly a few weeks later, but with broken ribs and probable brain damage. Undaunted by this warning, John elected to be resuscitated. And indeed, when the moment finally came and he was struck down by what was described on the death certificate as ‘ischaemic heart disease’, the paramedics did everything possible to revive him, and they seemed genuinely sad when they announced, after a long period of trying, that they hadn’t managed to save him.

There are inevitably those who suspect that non-resuscitation is just a callous way of saving the NHS money, or that it’s a form of disguised euthanasia. I don’t think so. John’s doctor, a good man, clearly believed that it was a compassionate solution to a nightmare problem. There will clearly be cases when it would be a mistake, and potentially a harmful one, to attempt resuscitation; but it’s a bit much to expect patients themselves to rule out in advance any possible recovery from a medical emergency that they cannot foresee. Rightly, doctors are now obliged by law to consult their patients before placing a ‘do not attempt resuscitation’ order on their medical records. But why does such an order need making at all?

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  • whatonearth

    I am confused by this article – you think it better if the elderly weren’t given the option? Is that the conclusion?

    • davidofkent

      I think the writer is wondering if there is any point in the expected ‘cold call to the over-75s’. I must say I agree with him. Even a named doctor will still spend most of a consultation looking at his computer screen.

      • whatonearth

        Yeah I have to agree, any emergency doctor is surely in a better position to judge the success of resuscitation than an otherwise healthy, if old, person possibly years before they might need it or even expect it! A very strange way of doing thing! Nevertheless, I think it’s wise to plan for death at a certain age, as gloomy as that sounds

        • whatonearth

          Though perhaps not over the telephone with a stranger..

          • Chris68

            How can you possibly plan for death at a certain age?! Spend your life planning for death at the ripe old age of what? 70, 80,90? Tomorrow you step outside and get mowed down by some youth. Fat lot of good your planning did!

          • whatonearth

            should i say: when you are at a certain age i think it’s wise to plan for death. If you’re 80 and you’ve not wrote a will, discussed whether you want to be cremated/buried/watever then you’re an optimistic, though perhaps foolish, 80 year old. Working out if you want someone to smash your ribcage apart fruitlessly trying to bring you back from the dead should perhaps be a part of that.

    • Mukkinese

      I think this is the start of another concerted press campaign like the one to demonise benefits. This is testing the waters on criticising the NHS and what is the best way to do that.

      Watch, they will try more and more of this kind of thing as time goes on. They want to see just how far they can push with the NHS before the public begins to resist…

    • IOAD

      Are you given the option?

      • whatonearth

        As far as I know, assuming the patient has capacity, they’re asked to consider signing a do not resuscitate order – it’s usually in cases where a patient has alot of comorbidities so the doctor strongly doubts that resuscitation will be successful (rescuscitaion would be mostly distressful for the patient, and their family – rescuscitation can be messy – we’re talking alot of broken ribs, tubes in and out of nose & throat, ECG’s…) or if it is successful the likelihood of recovering are very slim (i.e. if it is successful the patient is unlikely to ever recover – most likely scenario spending days in intensive care before dying, or worse still hooked up to life support in a comatosed state leaving it to the family to decide when they die). If the patient doesn’t have capacity then I think it’s a discussion with next of kin/power of attorney. This is usually all done in hospital though, I’ve never heard of it being discussed before hand. As far as I know – if there isn’t a DNR in place, the medical team has to attempt resuscitation.

  • Ivan Ewan

    What’s the status on the Liverpool Care Pathway? Is that still around?

    • whatonearth

      Not sure if it’s still used, I’ve seen patients with something called an Amber Care Bundle though which serves a similar sort of purpose (i believe)

  • carl jacobs

    Let’s cut to the chase, shall we?

    “Dear Old Person.

    You have reached the age where you will likely cost a lot of money if you get sick. As I am sure you understand, your economic value is long since spent. We therefore don’t see a good ROI in any potential treatment should you become incapacitated. We would therefore very much like it if you would agree to not be treated.”

    This is how the choice to refuse treatment becomes transformed into the obligation to die, and how the obligation to die will eventually become transformed into the compulsion to die.

    • Chris68

      This is exactly what I understood that article to mean. You have to be obtuse not to read through the lines.

      Rather than frighten frail and ageing people in to deathly oblivion, why not target the lardarses of the nation who are nothing but a weight on the health budget with their self-inflicted ailments through overeating, no exercise and binge drinking?

  • Diggery Whiggery

    Of course, what better way to save the NHS money and keep enough on hand to pay management vast salaries.

    It doesn’t matter what answer you give by the way. If you say that you don’t want to be resuscitated they won’t try at all, while if you say that you do want to be resuscitated, they won’t try very hard.

    Either way you’ll end up with a toe tag.

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  • Boleslaw Bierut

    Very good idea. I sometimes wish I didn’t wake up and that’s without NHS prompting.