A decision of life and death
An end-of-life draft policy aims to ensure that patients of all ages are offered options to ensure they retain their dignity, writes PAMELA DUNCAN
IN CONTRAST to his dapper bow tie and the cheery vase of sunflowers which decorated the podium, Dr Patrick Plunkett’s opening remarks to a meeting held in Dublin last Wednesday were quite sobering:
“This is to warn you, you’re all going to die,” he opened to ever-so-slightly nervous laughter from the assembled crowd.
However, Dr Plunkett’s comments are apt in the context of the meeting’s topic. Organised by the Irish Hospice Foundation’s Forum on End of Life in Ireland, the meeting was convened to discuss the ongoing national consultation process around Do Not Attempt Resuscitation orders (DNARs).
The subject is one of a number of end-of-life issues contained in a draft national consent policy developed by the National Consent Advisory Group under the auspices of the National Quality and Patient Safety Directorate, which is under national consultation until June 28th.
It is envisaged that the policy will be used across the Irish health system, including nursing homes. Its aim is to provide guidance to health professionals as to how best to sensitively obtain a valid and genuine consent from patients in their care.
Dr Plunkett, who is a clinical professor of emergency medicine at Trinity College Dublin, clinical director, emergency directorate at St James’s Hospital and commissioner at St John Ambulance Brigade of Ireland, pointed out that while there is a societal discomfort around the discussion of DNARs, doctors had a responsibility to their patients to discuss what was in their best interests.
“The predictability of death is such that we owe it to the person that we discuss it with them,” he said. “Death is inevitable . . . it will happen to us all . . . There is an excessive medicalisation of death,” he said, adding that many people having CPR inappropriately should be allowed to die “in their own time and in comfort and in dignity”.
“I’m very much supportive of Do Not Attempt CPR or Do Not Attempt Resuscitation as a pre-planned decision of a competent patient for their own final outcome and that that be respected by their doctors and nurses,” he concluded.
Dr Deirdre Madden, a senior lecturer in law at University College Cork (UCC) and chairwoman of the National Consent Advisory Group, said that for certain patients, a “procedure less dignified and peaceful [than CPR] could hardly be devised”, adding that, in many cases involving a terminally ill patient it could actually cause discomfort and injury to the patient.