I've been pointing to Thaddeus Pope a lot lately and for good reason; he's keeping us apprised of cases around the world that address futile care, and in a way that is provocative and not monolithic. That's refreshing when so often commentary regarding health care comes as announcements, not invitations to think. Take for instance the last paragraph in this quote from Pope's site of an article in the Yorkshire Post. Pope highlights the interesting bits that work to change the way we look at patient choice as limited only to effective care - that's a huge paradigm change from the rampant demand for treatments until the last days of life, regardless of their efficacy (see Montana Republican state senator Greg Hinkle in my prior post.)
Barbara Evans' daughter was "shocked" to discover that a DNR order had been written on her mother's medical notes. She explained, "I was shocked because this issue had never been discussed with either my mother or the family." (Yorkshire Post, June 1, 2010)
A Leeds Teaching Hospitals NHS Trust spokesman said:
The trust policy states explicitly that in most cases patients should be informed of any clinical decision not to attempt resuscitation. We do discuss cardiopulmonary resuscitation (CPR) decisions with patients and/or their relatives where we feel there is a genuine choice to be made – that is when we think that it could be successful, but even then the patient may not want CPR to be attempted. Our policy emphasises that, where there is a real, and difficult choice to be made, the patient's view is of paramount importance.The spokesman further explained:
However we may feel that to attempt CPR would be medically futile, and that there is no real decision for the patient or their relatives to make. Even then, we now recommend that most patients should be told, as part of the process of keeping them informed about the seriousness of their condition. For some patients, for example those who know that they are approaching the end of their life, information about interventions that would not be clinically successful would be unnecessarily burdensome and of little or no value. Such patients could be distressed by receiving what could appear to be unnecessary and unhelpful information, in the same way that we would not talk about an operation or other treatment that would not help them.