Hospital Watch


Instructions not to resuscitate certain patients the next time they suffer heart failure are issued daily by doctors in Irish hospitals without consulting anyone, a medical indemnity company says.

Often, the instruction is not written down, says an editorial in the latest newsletter of St Paul Ireland. "Significantly, such decisions are made without regard to either their ethical or legal status," it says.

Health authorities should develop policies on "Do Not Resuscitate" (DNR) orders, writes Mr Asim Sheikh, who lectures in legal medicine at University College Dublin, in the newsletter.

Currently, "there is a grave lack of ethical and legal certainty regarding the DNR order. There exist no Irish medical guidelines and there is neither legislation nor judicial wisdom to assist medical practitioners in this emotionally sensitive and legally uncertain area of medicine."

There is no doubt, he says, that DNR orders "are prevalent in healthcare" and that they are capable of being misused.

Doctors issue DNR orders where a patient is so seriously ill that if heart failure occurs it would not, in the doctor's opinion, be in the patient's best interests to resuscitate him or her.

While Irish doctors are in a legal limbo, the UK courts have accepted the concept of DNR orders in the best interests of patients, according to Mr Sheikh. They encourage consultants to get the views of other health professionals, of the patient and of the patient's relatives.

"The Department of Health, health boards and/or the Medical Council must deliberate on the issue of the DNR order so that a national and unified policy approach is adopted as opposed to a possibly disjointed local approach," he writes.

In an article on a related issue in the Lancet, Prof Des O'Neill of Tallaght Hospital questions the fears which cause people to give "advance directives" that they should be allowed to die in certain circumstances.

The "paranoia" that doctors will strive to keep them alive beyond all reason is like a modern version of medieval fears of being buried alive", he writes. This fear can "blind the general population to ageist currents in society, whereby a greater hazard in later life is likely to be undertreatment rather than overtreatment".

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