The Courier & Advertiser (Fife Edition)
Assurance over ‘do not resuscitate’ forms
Family says OAP received call from GP surgery, but chief medical officer says no new guidance pushing patients in light of virus
Nicola Sturgeon says nobody in Scotland should be forced into making decisions on “do not resuscitate” forms as a result of the coronavirus pandemic.
The first minister was responding after a family hit out at NHS Tayside when they learned their 86-year-old grandmother agreed to a DNACPR (do not attempt cardiopulmonary resuscitation) request from her GP surgery.
Helen Wray told The Courier her mother was sent the form – which identifies a patient who does not wish to have CPR performed on them should their cardiac or respiratory functions cease – after a phone call from a locum doctor at Ryehill Medical Practice in Dundee.
She said her mother, who the family asked to keep anonymous, was “happy to take a phone call from anyone”, but would rarely remember the discussion.
The DNACPR order, seen by The Courier, has a hand-written note on it that reads “telephone consultation as per Covid-19 protocol”.
Government body Health Improvement Scotland is said to have been sharing updated guidance on anticipatory care conversations during the Covid-19 outbreak.
However, asked about the issue at her daily coronavirus briefing at St Andrew’s House in Edinburgh yesterday, Ms Sturgeon said: “Nobody, not just in these circumstances but in any circumstances, should be pushed into anything like that.”
Scotland’s chief medical officer Dr Catherine Calderwood said there is “absolutely not” new guidance pushing patients towards signing “do not resuscitate” forms in light of the pandemic.
She said: “There is certainly not any protocol nationally or otherwise for pushing people into a ‘do not resuscitate’ signature.
“We have had a lot of conversations, in fact started by members of the public but taken on board by colleagues in primary care and in the hospitals, about people making their own wishes known were they to become significantly unwell. This is not something that is directly related to Covid-19.”
She said discussions around DNACPR decisions amongst families “at any time” is something that is “welcomed”.
Dr Calderwood added: “Because some members of the public say, having discussed it, they realise their relatives have their wishes all laid out for people to hear.
“Of course if people are wanting everything done, that is absolutely the right thing.
“Those shared decision-making conversations are happening and have been happening for many, many years across Scotland.”
She added: “These discussions perhaps are becoming more pertinent if people are going to become significantly unwell, but this is absolutely not something that we are discussing in the light of Covid-19, and pushing people into decisions that they would otherwise not be comfortable with.”
The British Medical Association was approached for comment, but chose not to give one.
However, a Dundee GP contacted The Courier in an effort to allay concerns.
The doctor said colleagues were being asked to raise the question of CPR with patients in order to ease the pressure on coronavirus units if and when they require treatment, and stressed a wide range of other less-invasive procedures would still be carried out.
“Decision to initiate CPR is a clinical decision,” said the doctor.
“GPs have been asked to consider anticipatory care plans in advance when patients are well to make things easier for coronavirus units and hospitals when they’re admitted, part of which is whether CPR is likely to be successful.
“CPR means chest compressions and artificial ventilation. It is a pretty invasive manoeuvre which usually crushes ribs, induces vomiting and is a pretty traumatic way to die once it fails on elderly. Do not resuscitate forms are not ‘do not treat’ orders. These patients will be considered for hospital treatment such as antibiotics and oxygen.
“Doctors have been given lists of thousands of patients who are high risk. We have to work through these lists to make sure appropriate info is available to hospital doctors as we have information that will not be available to hospital doctors.
“The decision about how to treat a patient and how far their care should be escalated remains the decision of the doctor in front of the patient when they become unwell, and that is not an easy decision.
“Care plans and do not resuscitate forms just make this difficult job a little easier in a time of huge pressure and uncertainty.”
Monica Lennon, Scottish Labour health spokeswoman, said more care should be taken over the “sensitive topic”.
She said: “For elderly or vulnerable patients to feel pushed or pressured into a ‘do not resuscitate’ agreement is appalling. In no circumstance should measures like this be put in place without an informed discussion with patients and their families.
“This is a worrying time for everyone, and the public needs to have confidence in the Scottish Government’s plans to steer the country through Covid-19.
“The health secretary must clarify what guidance has been given to GPs and health boards and reassure patients that this won’t be repeated.”