‘Do not resuscitate’ is a complex matter

Sir, – I refer to your headline Do Not Resuscitate (Letters, April 3).

As a GP with a special interest in palliative care, I believe this is an important matter to discuss.

It is time we brought the issue of resuscitation into the public conscience.

CPR is portrayed on television programmes as an intervention which produces successful results.

This is misleading. The grim facts are that cardiac arrests outside of hospital have a survival rate of less than 10%.

They are traumatic and undignified.

Those who do survive are often left with painful traumatic chest wall injuries such as rib and sternal fractures.

Furthermore, an inevitable interruption of oxygen to the brain leaves many with longterm neurological problems.

Needless to say, many of these individuals have a very poor quality of life on recovery.

It is important to stress that a “Do Not Resuscitate” order means only that.

It is not a sign that doctors are “giving up” on patients. It does not affect their medical care in any way.

It is simply a decision which guides the events surrounding their death and may make the difference between dying peacefully and preserving dignity or having a traumatic procedure carried out in the immediate aftermath.

As doctors, we often find that patients themselves would not wish to undergo CPR, but it is their families who oppose this decision.

Nobody likes to talk about dying; it is, however, our responsibility to do so.

Having this conversation is not new, however.

We have been discussing wishes surrounding end of life with patients for a very long time.

In doing so, we are trying to treat patients with respect, consider their wishes and empower them in making informed decisions, thus giving them a degree of control in the management of their death.

This is not about allocation of resources and there should be no pressure on patients to make this decision.

If, after considering the information I have mentioned above, patients still wish for CPR to be performed, this is respected and recorded.

It is understandable that family members are upset about these discussions taking place.

In some cases, carrying out CPR can help loved ones through their grieving process, knowing that everything that could be done was done.

I would encourage people to think carefully about their wishes, and discuss these matters with their families and GPS.

It is important that we get this right for everyone’s sake.

Dr Natalie Donald, GP. Bank Street, Cupar, Fife.