By the way... All of us should write a Living Will

WHAT should happen to you if you become so seriously incapacitated that you’re incapable of telling your doctors about the kind of treatment you’re willing to have?

For instance, whether you want them to try to resuscitate you if you suffer a cardiac arrest — an important question for patients with severe dementia, for instance, who might otherwise die peacefully and naturally.

What should medical staff do if you suffer brain damage and end up in a persistent vegetative state — do you want to be kept alive on a machine?

This is the kind of scenario covered by a Living Will — or what we doctors know as an Advance Decision (previously known as an Advance Direction).

Essentially this is a statement issuing instructions about what medical treatments you don’t want to have if at some stage you become so disabled you cannot discuss your care freely and openly with your doctors. Writing a Living Will is about thinking ahead. I hope they become routine, much the same as making a will about property and finances.

The subject is very much in the news following reports last week about Janet Tracey, a lung cancer patient admitted to hospital with serious injuries following a car accident.

Her family later discovered a ‘do not resuscitate’ order had been placed in her medical records without her permission. The Court of Appeal ruled that this had been a violation of her rights; this ruling means that health professionals are now legally obliged to consult with patients — or relatives — if they wish to put such an order in a patient’s notes.

Even before this ruling, I’ve always believed doctors had an ethical duty to hold conversations with patients about plans for their care. But the teaching and study of medical ethics is woefully inadequate in many places.

Nor is it only doctors and nurses who need this — hospital administrators and the regulators should also receive detailed training. I’ve tried to find out if all the members of the General Medical Council — the doctors’ regulator — have had formal training in ethics, but no one can tell me. It seems that the dereliction of the duty of ethical understanding extends to the highest level.

But perhaps now we will see some new focus, in tandem with greater awareness of the positive benefit of Advance Decisions, and I hope that all GPs will be prepared to instruct their patients in how to find and complete the correct documentation. After a suitably instructive chat about what the patient wants, of course.