Medical Association Doctors Want Rule Change on Resuscitation
Helen Rumbelow, Medical Reporter
- Wednesday, June 28 2000
qualified doctors are "coerced and cajoled" into refusing to resuscitate
dying patients, the medical profession said last night.
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.
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
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.
reality, too many DNR orders are made by unsupervised junior doctors,
usually at the request of nursing staff,"
Freeman said. "Frequently it is late at night, or in the middle of a busy
on-call weekend with patients moribund and relatives unavailable."
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.
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
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.
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