‘Do not resuscitate’ is doctors’ own choice for end-of-life care – but perish the thought to educate patients!

Billy Kenber reports for The Times 29th May 2014 on an issue that doctors are able to decide for themselves on. They have no longer got complete clinical freedom over their patients, but with planning, cooperative relatives and an “Advanced Directive” they can ensure a speedy release. This is something that most patients fail to address and the consequence is a higher percentage of prolonged deaths in the general public: ‘Do not resuscitate’ is doctors’ own choice for end-of-life care 

With apologies, as I believe this is important, I reprint the complete article below:

Most doctors would ask to be left to die if they had a terminal illness, rather than pursuing the aggressive treatments they recommend for patients, a study indicates.

A survey of almost 1,100 doctors found that 88.3 per cent would opt for a “do not resuscitate” approach if they had terminal cancer or another illness that would soon kill them anyway.

Dr V J Periyakoil of Stanford University School of Medicine, in California, who carried out the research, suggested that doctors’ decisions were influenced by regularly witnessing the impact of efforts to extend life, including resuscitation attempts that could break an elderly patient’s ribs but would not return them to their previous state of health.

She said there was a disparity between what doctors would choose for themselves and their pursuit of aggressive treatments for patients. Dr Periyakoil said this was not for financial reasons or because doctors were intentionally insensitive towards patients.

She said that the medical system was set up in a way that rewarded doctors for taking action, not for talking with their patients. “Our current default is ‘doing’, but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself,” Dr Periyakoil, a clinical associate professor of medicine, said.

“It’s tricky, but physicians don’t have to figure it out by themselves. They can talk to patients and their families and to the other interdisciplinary team members, and it becomes much easier. But we don’t train doctors to talk or reward them for talking. We train them to do and reward them for doing. The system needs to be changed.”

The study examined doctors’ attitudes to a new law designed to give patients more control over determining end-of-life-care decisions. Advance directives, or so-called living wills, are documents which allow patients to indicate their preferences for medical treatment when they are terminally ill or otherwise incapable of making decisions themselves.

Although other studies have indicated that the majority of Americans would prefer to die at home without life-prolonging interventions, hospitals remain focused on aggressive treatment at the end of life.

Dr Periyakoil surveyed 1,081 doctors in California, of whom 60 per cent were between 30 and 39 years old.

The results showed that doctors’ attitudes toward advance directives had barely changed in 25 years and that women remained more supportive than men of patients being able to set out their end-of-life choices.

An advanced directive or living will – It’s important to specify, especially lying flat. Good news if you take action.

Nuffield Trust: changing health care services and living with less

Dead people don’t vote… End-of-life care ‘deeply concerning’

Death discussions ‘taboo’ for many in UK, survey finds

The NHS and ‘cradle to the grave’

at least the profession are able to “commission” their own “end of life” care standards, and ration themselves out of pain and distress!

 

 

This entry was posted in A Personal View, Commissioning, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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