LONDON, England / The Telegraph / Health News / May 31, 2011
Terminally ill patients are to be asked by their doctors to write down how they want to die, under new guidelines to be unveiled today.
Doctors want to encourage more dying patients and their relations
to discuss their deaths and write down their wishes Photo: ALAMY
By Stephen Adams, Medical Correspondent
Dying people will be encouraged by GPs to set out clearly whether they wish to be resuscitated by medical staff and how they want to be treated in their final days.
A legally binding record of their wishes will then be kept, potentially on the new NHS database, so staff other than the family GP could be able to tell how to treat a dying patient in A&E or in an ambulance.
The advice is contained in the first patients’ charter, drawn up by the Royal College of GPs and the Royal College of Nursing.
The charter, to be posted in 8,500 family surgeries in England, is announced today amid growing concern over how the dying are treated.
Besides damning reports about care for the elderly and infirm in hospitals, there have also been high-profile cases in which relations have complained that their loved ones’ wishes were ignored.
In some instances, staff have been accused of putting patients on a fast track to death by taking away life support without relations being informed.
The Liverpool Care Pathway, a palliative care programme designed for cancer patients, has come in for particular criticism, with some experts warning that patients who might still recover are being allowed to die unnecessarily.
In 2007, the Mental Capacity Act came into force, under which people could stipulate “advance directions” about how they wanted to be treated if they became incapacitated. However, these guidelines have been taken up by only a few people.
Doctors want to encourage more dying patients and their relations to discuss their deaths and write down their wishes.
The charter pledges that doctors and their practice teams will “assist you to record your decisions and do our best to ensure that your wishes are fulfilled, wherever possible, by all those who offer you care and support”. Two of the seven points in the charter mention that patients’ intentions should be written down.
In the second instance, it advises that doctors and nurses should “ensure clear written communication of your needs and wishes to those who offer you care”.
Wishes could be recorded on the computerised NHS database of medical records, which is currently being developed.
For example, a patient might be taken ill in the night, driven to hospital in an ambulance, and die in casualty. Even if the GP knew the patient’s wishes, casualty staff would not.
Medical legal experts said such written requests could be used in court by doctors as evidence that they had taken patients’ wishes into account, or by family members seeking to prove they had not.
Charles Foster, a leading barrister and a lecturer in medical ethics at Oxford University, said: “They could be used by doctors, by relatives and on the patients’ behalf.”
If properly prepared – signed and witnessed – they would carry the same legal weight as advanced directions, he said. He warned that people should know that patients often wanted to hold on to life at the bitter end.
He said: “Because we value life so much, when we have everything stripped from us, we value all the more what we have left.”
Andrew Davies, a consultant in palliative medicine at the Royal Marsden Hospital in Surrey, said written requests that stipulated treatment be withheld – for example requesting no resuscitation – already carried significant legal weight.
Those that stipulated actions that should be taken to keep the patient alive carried less weight, he said.
Some anti-euthanasia campaigners fear that doctors could interpret parts of the charter as a green light to help people die.
Kevin Fitzpatrick, of the organisation Not Dead Yet, said he was “outraged” by what he described as “a blatant attempt by GPs to circumvent the law”.
The charge was dismissed by Dr Gerada, who said the RCGP’s position remained that there should be no change in the law on assisted suicide.
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