Doctors’ dilemma
PeoPle need to understand how ‘DNR’ (do not resuscitate) instructions on patients’ notes (Mail) came about.
About 60 years ago, cardiac arrest teams were organised in hospitals on a 24/7 rota, consisting of a resident anaesthetist and one other doctor, equipped with dedicated bleepers that could direct them to the ward making the call.
They were not sitting around waiting to be called, but busy doing their routine work anywhere in the hospital, eating or sleeping. It meant an improved service for those in urgent need, but depended on the ward nurse, often an inexperienced junior, having to make a decision to alert the team.
The doctors then had to read all the notes and delay urgent treatment or start treatment before learning that the patient couldn’t benefit as their disease was terminal.
In most cases, the patient had already received all available treatment and couldn’t benefit from resuscitation. To avoid much waste of manpower, drugs and equipment, such patients had DNR written on their notes by the doctors in charge of their treatment.
only a few cases can be treated successfully after the heart has arrested, which are those where the cause of the arrest can be reversed.
These include coronary occlusion ( heart attacks), electric shock, embolism, suffocation, drowning, haemorrhage, hypothermia, poisoning (including gas), severe head or chest injury and a few rarer incidents.
Most DNR alerts are therefore written by doctors, but recently some patients have chosen voluntarily to refuse resuscitation because they fear the pain and possible indignity of intensive treatment and interference.
Determining where treatment ends and resuscitation begins is difficult, a decision sometimes made later in the law courts. Asking patients to sign away their lives is contrary to doctors’ and nurses’ beliefs.
Dr C. F. J. POTTER, Hythe, Kent. As A 76-year-old, I sometimes wonder what’s wrong with the ageing population of this country. once you’re over 70, you’re on the downhill run and as little money as possible should be wasted by the NHs in keeping you alive.
Any hospital treatment should just be to make you comfortable — certainly not life-saving treatment to enable you to live for years and years.
As for the ‘Do Not Resuscitate’ instruction, it should be the responsibility and duty of everyone to inform their next of kin of their wishes, put it in their will and inform the people handling it.
For goodness sake, you can’t live for ever! Grow old gracefully and stop fighting the unstoppable.
GEOFF SMITHARD, Hawkinge, Kent.