British Medical Association Doctors Want Rule Change on Resuscitation

By Helen Rumbelow, Medical Reporter

THE TIMES(UK) - Wednesday, June 28 2000

NEWLY qualified doctors are "coerced and cajoled" into refusing to resuscitate dying patients, the medical profession said last night.

The British Medical Association's annual conference voted for hospitals to change their culture so that life-or-death decisions are no longer made at the last minute by inexperienced trainees with no opportunity for discussion with the patient or senior staff. The conference was told that it was common practice for a junior doctor to be summoned to an unfamiliar patient whose heart had stopped and to be pressurised by nurses to enter a "do not resuscitate (DNR)" order in their notes.

Alex Freeman, a GP from Southampton, said that this defied BMA guidelines, which state that consultant doctors are responsible for DNR orders and that they are advised to discuss such a decision with the patient or their relatives.

The conference overwhelmingly voted that the BMA should consider changing the guidelines so that, where possible, written consent should be obtained from the patient or the family. At the very least that would ensure that the patient had been informed about the decision not to resuscitate; at most it could allow the doctor's decision to be over-ruled.

"In reality, too many DNR orders are made by unsupervised junior doctors, usually at the request of nursing staff,"

Dr Freeman said. "Frequently it is late at night, or in the middle of a busy on-call weekend with patients moribund and relatives unavailable."

Dr Freeman proposed the motion on behalf of a doctor who worked at St Mary's Hospital in Portsmouth, where Jill Baker, a 67-year-old recovering from breast cancer, had been "understandably distressed" to see that a junior doctor had written "DNR" in her notes without discussion.

Dr Freeman said that senior staff had failed to support juniors by properly assessing which of their patients were suitable for resuscitation. "The message for patients needs to be: 'if your doctor is not talking to you about resuscitation, then you need to talk to your doctor,' " Dr Freeman said.

Mark Porter, an anaesthetist from Coventry, told the conference about an occasion early in his career when he was called to help nurses trying to revive a terminally ill patient. When he arrived they simply persuaded him to sign the DNR order. "That case was sadly typical," Dr Porter said.

Jonathan Fielden, an intensive care specialist from Reading, said the public had to be informed about the limitations of resuscitation in order for them to contribute to the decision. "The result is not as successful as on ER and Casualty, where 50 per cent of resuscitations work," Dr Fielden said.


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