Doctors to ask: ‘Do you want us to save you?’

NHS Scotland is set routinely ask patients if they would want to be resuscitated – or would prefer to be allowed to die – under plans to transform end-of-life care.

Doctors will also ask if patients would be prepared to receive other invasive or extreme treatments, such as being fed through a tube or kept alive on a ventilator.

But campaigners have warned that the scheme could be a ‘disaster’.

The move is part of a drive to make healthcare more ‘realistic’, recognising that, although modern medicine is able to keep people alive even in the most challenging circumstances, quality of life may be so badly reduced that it may not always be what a patient wants.

Now a radical pilot project has been set up in which GPs, hospital doctors and nurses will ask what ‘care and realistic treatment’ patients would or would not want in an emergency.

Medical staff will discuss the issues with patients – particularly the elderly or those with severe medical conditions – then record their wishes on a form which the patient keeps with them.

The proposals, drawn up by a range of influential professional bodies including NHS Scotland, are designed to give people more say over what happens when they are at their most vulnerable.

If successful, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) scheme could be extended across the country.

Under current protocols, patients in the final stages of terminal illness, after discussion between the patient, their family and their doctors, can be subject to a Do Not Attempt Cardiopulmonary Resuscitation order, which means no attempt will be made to restart their heart if it stops.

However, under the new scheme more patients would be asked to make a far wider selection of choices about what end-of-life care they would consider acceptable, at a much earlier stage in their treatment.

Last night patients’ rights campaigners said the plan could be a ‘disaster’ if not handled sensitively.

Health policy analyst Roy Lilley said: ‘This is a bone-china, cut-glass policy that, if you’re not careful, will be delivered by a bull in a china shop. In the hands of a doctor or nurse who is well known to the patient, then these very important matters can be addressed. However, done by a cack-handed stranger, it can be very upsetting.

‘Relatives who may benefit from the will or an inheritance might hasten the day for mum. There is plenty of opportunity for things to go horribly wrong.

‘But I understand it from the policymakers’ point of view. They are hoping to discourage people being plugged into machines, discourage people being revived and resuscitated because they don’t have the beds, they don’t have the money and we’re all living too long.’

The scheme, to be trialled by NHS Forth Valley, was drawn up after a review of Do Not Attempt Cardiopulmonary Resuscitation forms. Patients will be asked about their ‘care and treatment preferences’ and the answers recorded on a form, which is not legally binding and not signed by the patient.

The ReSPECT website says: ‘Ideally, over time most, and possibly all, residents in a care home should be offered the opportunity to have a ReSPECT conversation and develop a plan.’

Federico Moscogiuri, chief executive of the Resuscitation Council (UK), one of the organisations behind the plan, said: ‘We believe this will improve the quality of care and lead to a culture shift within emergency and end-of-life care.’

NHS Forth Valley medical director Andrew Murray said: ‘The plan may include information about specific treatment – for example, clinically assisted nutrition or whether the patient would like to be admitted to hospital. This puts them at the centre of decision-making.’

But former GP and patients’ rights campaigner Dr Jean Turner warned: ‘It mustn’t be done in a hurry... You also don’t want to scare people to death with inappropriate timing.’

Dr Miles Mack, chair of the Royal College of GPs Scotland, said: ‘Resuscitation, like any treatment, has benefits and harms. As GPs we have the opportunity to have discussions with our patients, should they wish, to ensure the treatment we offer now and in the future is appropriate and in keeping with our patients’ wishes.’

The Royal College of Nursing’s associate director, Ellen Hudson, said the RCN supported the approach.

‘Plenty of opportunity for things to go horribly wrong’