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"Only a senior consultant should rule a patient should not be resuscitated"
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Thursday, 13 April, 2000, 09:49 GMT 10:49 UK
NHS ageism row sparks action

Jill Baker: 'Do not resuscitate' instruction
The government has pledged to stamp out age discrimination in the NHS after allegations that doctors decide not to revive seriously ill elderly patients.

Age Concern says doctors are increasingly ignoring the wishes of patients - and sometimes not even asking patients - when it comes to making resuscitation decisions.

I was absolutely horrified. They were going to let me die

Jill Baker
Dr Sheila Adam, the deputy chief medical officer, said a blueprint for care of the elderly would be published next year.

She said: "Age Concern is right to raise these individual cases, they obviously do raise concerns and they must be fully investigated, but we are taking action to develop a blueprint which will tackle any discrimination that is currently taking place."

British Medical Association guidelines state that patients or their relatives should be consulted about any decision not to resuscitate.

But the BMA has admitted that some junior doctors may be too nervous to involve patients and their relatives in discussions about whether to revive or not.

Age Concern is calling for a full inquiry into the treatment of the elderly.

On Thursday, the case was highlighted of a cancer patient who discovered that, had she fallen unconscious in hospital, doctors would have made no efforts to resuscitate her.

Jill Baker only found out after she left hospital that the comment "inappropriate for resuscitation" had been written on her notes.

Neither she nor her husband had been approached or asked for their views on the subject.

Hospital notes

Despite being "written off" by a doctor who had not even met her, nine months later she is alive and enjoying life.

Campaigners said the case highlighted the way doctors were flouting guidance on so-called "end of life" issues and making decisions without the permission of patients.

Neither Mrs Baker nor her husband were consulted, they claim
Mrs Baker, 67, from Portsmouth, who has stomach cancer, was admitted to a ward in the city's St Mary's Hospital last July after a tube used in her chemotherapy treatment became infected and she developed septicaemia.

She eventually discharged herself because she was unhappy with her care and demanded to see her hospital notes.

A doctor had written on top of the records: "In view of the underlying diagnosis (cancer), in the event of cardiac arrest or stroke, resuscitation would be inappropriate."

The note also said "Do not ring 555" - the hospital number for the resuscitation team.

Mrs Baker said: "When I read this I was absolutely horrified. They were going to let me die."

"My husband was sitting with me all the time I was in the ward and no-one talked to us about this or asked our views. I never even met the doctor who wrote this and she hasn't met me."

She said: "Before I was admitted people said the ward was called the death ward and after my experience I believe it.

"I am a founder member of the NHS - I have paid for it from the very beginning - but my husband has now said he would rather sell everything we own and go to private healthcare than let me go into that ward again."

'Increasingly common'

A spokesman for Age Concern said Mrs Baker's experience was becoming increasingly common.

He said: "We are getting a call a month from someone saying this has happened to them or their relatives.

"It is absolutely dreadful and highlights the fact that elderly people are not getting the care they are entitled to."

A spokeswoman for St Mary's Hospital said: "The hospital has admitted that the Do Not Resuscitate message was put on Mrs Baker's notes inappropriately.

"The doctor involved was formally seen by the medical director but no longer works for the hospital."

She added: "Mrs Baker has made a series of complaints and is now part of the formal complaints procedure."

It is often easier for doctors to say I will make a decision as to what is in the patient's best interest, and perhaps overlook the necessity to share that decision with the patient

Dr Michael Wilks, chairman British Medical Association ethics committee

BMA guidelines say that if there is any disagreement on resuscitation between doctors and patients or relatives, hospital notes should make the dispute clear.

The BMA denies making resuscitation decisions on grounds of age but Dr Michael Wilks, chairman of the BMA's medical ethics committee, admitted the bedside manner of doctors can be improved.

He said it was extremely difficult - particularly for junior doctors - to initiate a discussion about resuscitation with a patient.

"It is often easier for doctors to say I will make a decision as to what is in the patient's best interest, and perhaps overlook the necessity to share that decision with the patient.

"We need to improve our procedures for discussing this with relatives.

"We should also ensure some of our junior staff are better trained to carry out this task."

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See also:

30 Jul 99 | Health
Elderly 'denied cancer care'
08 Nov 99 | Health
Elderly attack 'NHS ageism'
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