Resuscitation and end-of-life care
Sir, – Dr Muiris Houston’s article “Stop the barbaric practice of using CPR on the very old” (Medical Matters, Health + Family, April 4th) highlights one of the dilemmas faced by healthcare professionals in the absence of meaningful advance discussion on end-of-life care plans with patients, and between patients and their families.
It highlights the importance for both doctors and patients to talk about dying and death and for us all to communicate and record preferences for end-of-life care.
New research published by the Irish Hospice Foundation (IHF) – A Perspective on Advance Planning for End of Life – suggests many healthcare staff are not prepared or trained to help patients with life-limiting illness plan for end of life.
The IHF has been encouraging people to talk and plan for end of life through its citizen-led initiative Think Ahead. Using a simple form, Think Ahead urges people of all ages and at all stages in life to think about, talk about, tell, record and review their wishes for future medical and personal care, financial and legal arrangements. This can then be easily accessed in an emergency.
The form includes an area for advance healthcare directives – legally binding documents – through which a patient can record the medical treatments they would not like to receive in the event they are unable to communicate that wish in the future.
That could, of course, include recording a preference not to have cardiopulmonary resuscitation (CPR).
Even if not fully completed, the form can simply be used as a guide to those things people might want to think about when considering circumstances in which they are unable to speak for themselves. It can help initiate a conversation with loved ones and with healthcare professionals. Think Ahead enjoys considerable support from GPs and research on introducing Think Ahead in general practice shows it to be an acceptable and effective tool.
The IHF believes that a population-wide approach is required to health, financial, legal, administrative, educational and cultural issues relating to end of life.
Perhaps it is time for a national debate encouraging people to acknowledge the need for future planning, to enable them to make important decisions for themselves and to support them in loss.
In particular, the Government must commence the Assisted Decision-Making (Capacity) Act 2015 speedily. Until that happens, many of our citizens continue to have their decisions mediated by the provisions of the Lunacy Regulations of 1871.
Encouraging thought and discussion about end-of-life preferences is the responsibility of both the health services and wider society and can benefit both. It can help us all get on with the business of living. – Yours, etc,
The Irish Hospice
Nassau Street, Dublin 2.
Sir, – Muiris Houston is right to question the inappropriate use of CPR in the elderly. The procedure was recently described in the British Medical Association Newsletter as “the routine, institutionalised electrocution and torture of the dying”.
Count me out. – Yours, etc,
Dr JOHN DOHERTY,
Co Dhún na nGall.