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"At the core of these new guidelines is the principle that the patient should be treated as an individual"
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Former patient Jill Baker
"A junior doctor who had never met me made the decision that I was to die"
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Wednesday, 28 February, 2001, 02:26 GMT
New guidelines for reviving patients
Emergency treatment
Elderly patients feared age could be a bar to resuscitation
The medical profession has announced its guidelines to end confusion on when it is acceptable not to resuscitate a patient.

They call for closer consultation with patients to ensure their wishes are taken into consideration.

Age Concern are hailing this as a victory for the UK's elderly who feared they were at risk of not being revived simply because of their age.

The joint guidance of the British Medical Association, Royal College of Nursing and Resuscitation Council (UK) hopes to finally end the confusion over do not resuscitate orders (DNR's).

The guidelines follow a string of reports last year when seemingly healthy patients discovered they had "do not resuscitate" or DNR orders written in their medical notes.

Age concern will not rest until the "writing off" of patient's lives on the basis of their age has been stamped out

Gordon Lishman, Age Concern's director general

Gordon Lishman, Age Concern's director general, said Wednesday's guidelines will offer some reassurance to the elderly population, who were terrified by reports that DNR orders were being written in their medical notes without consultation.

He said: "Age Concern will not rest until the 'writing off' of patients' lives on the basis of their age has been stamped out.

Involving patients

"It's vital that the guidelines are fully implemented and monitored, which means making strenuous efforts to ensure patients and when appropriate, their relatives and carers, are involved in the decision-making process surrounding resuscitation."

He said Age Concern was proud to have played "the critical role in bringing about the government's policy change" , not only on the issue of 'Not for resuscitation', but also in terms of their "acknowledgement that ageism does exist in the NHS".

Mr Lishman added it is vital that elderly people are consulted about resuscitation and asked for their views.

A DNR order means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering.

Last year the government said it wanted all hospitals to draw up a clear policy on DNRs and the joint guidelines will make this easier.

Identify patients

The guidance states that advance decisions not to resuscitate patients should on be made only after looking at every aspect of the patient's care and taking into consideration the patient's wishes.

When is it appropriate not to resuscitate
When it will not restart the heart or breathing
When there is no benefit to the patient
When the benefits are outweighed by the burdens

The guidance calls for medics to work more closely with patients and explain to them the facts about resuscitation.

It also says doctors must clarify in advance where possible whether someone wishes to be resuscitated if their heart stops working.

The guidance also encourages medical staff to sensitively discuss DNRs with patients and to make sure they are aware that resuscitation is very different in reality from the way it is portrayed on medical TV shows.

It says carrying out resuscitation can result in broken ribs; fractures or ruptured spleen, and that patients may need to spend some time in intensive care or could suffer brain damage.

But it adds the procedure should be carried out where the benefits outweigh the risks.

Dr Michael Wilkes, chair of the BMA's medical ethics committee, said it is important doctors handle DNR conversations sensitively.

He said: "These are difficult conversations which need to be handled sensitively."

Dr Wilkes said it was important that whenever possible consultants and senior doctors take the decisions.

"Clear documentation in the medical and nursing notes about any advance decision is essential and junior doctors must be able to access support from more experienced colleagues," he added.

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