So: Addenbrooke’s hospital are being sued for allegedly illegally using a ‘do not resuscitate order’ on a patient. The patient had allegedly expressed that she wished to be resuscitated, but apparantly the order was written anyway.
Meantime, we have Iona Heath writing in the BMJ about how CPR “amounts to yet another scenario within contemporary medicine where the chance of benefit for the few creates procedures that risk the peace and dignity of the many. I only hope that by the time I am old and sick I will have to actively opt in for CPR, rather than my consent being assumed unless I have opted out.”
There is something troubling me, and it is to do with the perceived power of doctors over life and death. CPR is not a great treatment, and it does harm. I don’t just mean fractured ribs or blood loss or bruises, I mean what the meaning of death is.
Doctors who have looked after patients in the last stages of their life hope that a good death can follow. Sometimes family members can understandably panic when life is ebbing, especially if there seems pain or distress. The problem that ambulance crews have is that they work to a protocol where they must resuscite any dying patient; and what should be a time of comfort and togetherness becomes a medical battleground. It is hard for a doctor to arrive and to call time and stop a ‘treatment’ that should never have been started. We seem to regard death as something that should always be obstructed. Death is seen as a failure of medicine rather than an inevitability of life. This is dangerous.
When we start to instruct doctors to offer ineffective and harmful treatments, such as CPR when it has little or no chance of a good outcome, we are opening medical professional behaviour to the vagaries of consumerism. We should always perform CPR if there is a good change of benefit – even a small chance of benefit. But if doctors are to be told to prolong suffering, or contaminate a good death with our invasion and orders, medicine becomes actively harmful. I have seen patients asked if they want CPR even when, through their combination of several serious and lifelimiting illnesses, there would be marginal if any chance of success, and much of harm. Is this fair? Read this review in the Journal of Medical Ethics. Or there is more evidence about the effectiveness of CPR here. If we are serious about ‘dying well‘ we have to accept the futility of much of medicine, and instead allow care – decent, compassionate, ethical – to shine through.