End-of-life form could leave vulnerable at risk, say doctors
HOSPITAL patients may be left to die because a new form for Do Not Resuscitate cases is too complicated, experts warn.
The two-page Emergency Care and Treatment Plans are being introduced later this year to encourage staff to talk to patients and relatives about dying.
They are intended to replace DNR orders which have often been slipped into patients’ notes by doctors without consulting families.
But experts say the new forms are so confusing that doctors will not fill them in properly or have the sensitive discussions required.
Some campaigners say they will encourage more box-ticking and repeat the mistakes of the controversial Liverpool Care Pathway.
This involved fluid and food being with- drawn from dying patients and was abolished two years ago after concerns raised by the Mail that it was causing harrowing suffering.
The new form – revealed by Health Service Journal – was drawn up by a panel of 36 experts after patients died when DNR orders were wrongly put in their notes. They included Janet Tracey, 63, who died in 2011.
She had been in a car accident and had terminal lung cancer but her family said she had ‘every will to live’ and spend time with her four children and seven grandchildren.
Her daughter Kate Masters – who now cam- paigns for improved end-of-life care – said the forms would repeat the mistakes of the Liverpool Care Pathway.
She is concerned families and patients will not be involved in discussions and decisions on resuscitation will be hidden.
The forms will be issued for those regarded as nearing the end of their lives: the elderly or those with serious long-term conditions.
They will not be compulsory but hospitals will be encouraged to use them in place of DNR orders. Doctors will sign to state if a patient is ‘for’ CPR resuscitation or ‘not for’.
Controversially, they must also state if a patient’s priority is to ‘get better’, be just offered ‘comfort’ or something inbetween.
Professor Patrick Pullicino, a consultant neurologist at East Kent University Hospitals, is very concerned doctors were even being asked this when they should seek to make all patients better. ‘It muddies the water. It’s dangerous,’ he said.
Solicitor Merry Varney, of Leigh Day who represented Mrs Tracey’s family, told HSJ the form could repeat the pathway’s mistakes.
She said it did not solve the problem of ‘a very paternalistic view by some doctors that it is their place to decide’ or establish ‘clear communication’ with patients and families.
Dr Elin Roddy, a consultant in respiratory medicine at Shewsbury and Telford NHS trust and an expert in end of life care, said the form was ‘very confusing’.
‘It muddies the water
and is dangerous’