Doctors to ask patients: Do you REALLY want to LIVE...?
Latest guidelines will offer ‘right to die’ to the terminally ill
TERMINALLY ill patients will be offered the right to die without medical interference under new guidance for the NHS.
Doctors have been told to offer dying patients the option of refusing invasive treatments that would prolong their lives.
Scotland’s Chief Medical Officer has called on doctors to have ‘open, honest and very frank’ conversations with dying patients who may not want to end their lives ‘full of tubes and drips’ in hospital.
Dr Catherine Calderwood, the Scottish Government’s top doctor, said many doctors themselves would not want invasive treatment towards the end of their own lives.
The policy marks a landmark move in the way dying patients can expect to be treated.
Hospital consultants are now drawing up new guidance for intensive care department staff, on how to ask families whether a patient would really want the ‘burden’ of a poor quality of life – so they can decide whether to attempt potentially life-saving treatment.
The move has been welcomed by doctors, but critics have warned patients should ‘not be written off’ even if they are terminally ill. Dr Jean Turner, patron of the Scotland Patients Association, said: ‘Patients should be diagnosed as quickly as possible so that all that can be done for them is done and they are not written off too easily.
‘It’s important that patients are not pushed into this. Everyone’s circumstances are different. Some people do want to live longer, such as those with young families, so it needs to be a process and the patient treated as an individual.’
Dr Calderwood revealed the strategy in talks with medical professionals, following a report earlier this year where she called for more ‘realistic medicine’ and a move away from the ‘doctor knows best culture’ which has led to some patients receiving unnecessary treatments.
The move also contradicts recent decisions by Scotland’s drugs regulator to approve expensive treatments which can prolong the lives of cancer patients for weeks or months amid growing financial pressure on the NHS.
Dr Calderwood said: ‘Eighty-eight per cent of doctors would not have dialysis at the end of life, 67 per cent would not agree to be admitted to intensive care and 95 per cent would not have CPR. So we wonder, why do we prescribe or advise these treatments for our patients?
‘We understand for ourselves what we would do but are not translating that into care for their patients.
‘What I would like is that when we are speaking to people, we talk to them about whether the benefits of this treatment are what they need, and for them to ask us: What are the downsides? Are there any alternatives? What would happen if I do nothing? In one particular case a mother died in intensive care full of tubes and drips and it was so far away from what that lady had said her preference would be when she came to the end of her life.’
Dr Calderwood said research showed doctors thought dying patients wanted to live longer – but patients themselves prioritised being symptom-free and spending time with their families.
She said: ‘People understand we want to improve things for them, sometimes it needs to include doing less or doing very little.’
Mark Hazelwood, director of the Scottish Partnership for Palliative Care, said: ‘It is important that doctors, the NHS and the public acknowledge that there are limits to what medical interventions on their own can realistically achieve. The end of life can be complicated and difficult for patients, families and doctors – open, honest, realistic, timely communication is vital.’ A Scottish Government spokesman said: ‘Our Strategic Framework for Action on Palliative and End of Life Care works to ensure that people, their families and carers have timely and focused conversations with professionals to plan their care and support towards the end of life.
‘The Scottish Government has committed to ensuring that by 2021, everyone who needs access to palliative care will have it, supported by £3.5 million over the next four years.’
There are limits to what medical interventions can achieve Eighty-eight per cent of doctors would not have dialysis at the end of life DR CATHERINE CALDERWOOD