This question came as bolt out of the blue from a GP I had never met and who had spent less than five minutes with my mother whose health had, I cannot deny, suddenly gone down-hill rapidly.
To be handed the on/off switch for my mother’s life so abruptly and unexpectedly, made all the more distressing given her relative good health just the day before, was peculiarly bizarre and felt like a scene out of H G Wells’ The Time Machine with the Morlocks and Eloi.
What started as a pretty ordinary day had suddenly becomes extraordinary with the spectre of death hanging over me, or rather my mother, and all rational thought went out of the window as the doctor turned something that is emotionally distressing at the best of times into a simple yes or no response.
Now as it happens there was no need for me to organise her death warrant because she pulled through but the event was a warning shot across my bows about the inevitability and dare I say, closeness of her demise.
And that’s the problem, none of us like to think about death or dying; even though it is a dead certainty; we would rather not have to face it in advance, the consequence of which often means someone else will have to on our behalf.
Which is why I found out a little bit more about the whole Do Not Resuscitate (DNR) order and what is involved.
DNR is a legal order stating the person named must not be resuscitated using cardio-pulmonary resuscitation (CPR); treatment includes defibrillation and chest compressions. The survival rate of CPR is between 15-20%.
Now if you can picture some of those scenes from the TV drama Casualty when a full sized strong adult is frantically pushing down on someone’s chest or placing pads or paddles on them to send an electric current through them, you begin to realise just what is involved, particularly if the patient is frail and elderly as opposed to a stage prop.
It is not uncommon, even under the most experienced medical hands for the patient to suffer broken ribs, damage to the liver, lungs or spleen and brain damage, further reducing the patient’s survival rate.
Without a DNR in place it is presumed the patient will be given CPR unless the person is in the final stages of a terminal illness.
In 2014 the Court of Appeal ruled doctors have a legal duty to consult with patients if they want to put a DNR order on medical notes; the two most recent events that led to this judgement were Janet Tracey who had terminal lung cancer and was being treated in Addenbrooke’s Cambridge and Michael Richardson who also suffered from a respiratory disease; both had DNR orders on their medical notes that had been put on by consultants without prior discussion with the patient or family members.
Master of the Rolls, Lord Dyson said ‘there should be a presumption in favour of patient involvement … doctors should be wary of being too ready to exclude patients from the process on the grounds that their involvement is likely to distress them’.
A DNR order respects the wishes of the person when they are unable to express them due to ill health; it is likely that they would have made the decision when they were in good health and could have formed part of the ‘living will’ or ‘life plan’. But if the person’s wishes are unknown, the family and/or friends can be consulted but ultimately the decision rests with the consultant who may feel the patient would suffer more if they were given CPR. But doctors must justify their decisions and keep a thorough record of discussions with the patient and family unless the physician fears discussion will cause physical or psychological harm.
It is important for the person and family to understand the likely expected quality of life they will have as the DNR is designed to prevent any more suffering.
However some fear DNRs will be used as a passive euthanasia; Age Concern fear it may put the elderly at risk of not being revived simply because of their age.
The National Council for Palliative Care (NCPC) Chief Executive Claire Henry’s response:
“this ruling underlines why we need a national conversation on dying, so that people become more comfortable in talking openly about dying … and become better equipped to make difficult decisions …”
But who of us really wants to think too deeply about our mortality and commit to paper a decision about our final few minutes of life?
Or are we being too sensitive about something that is inevitable and is simply a part of ‘life’?
My mother made a rapid recovery and is back to her normal self, but I still cannot bring myself to discuss with her just when she wants to be left to die.