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Friday, 28 April, 2000, 00:45 GMT 01:45 UK
'Curb doctors' life or death powers'
Intensive care patient
The NHS has been accused of ageism
Legislation is needed to ban doctors from deciding not to resuscitate seriously ill patients without consultation, a leading doctor has said.

Professor Shah Ebrahim, from the University of Bristol's Department of Social Medicine, says over two thirds of patients with do not resuscitate orders are not involved in making these decisions.

Writing in the British Medical Journal, Professor Ebrahim cites recent reports that seriously ill elderly patients are being allowed to die by doctors in the UK as proof that expert guidance drawn up by the British Medical Association, the Resuscitation Council and the Royal College of Nursing is regularly flouted.

At present reverence for clinical freedom is simply allowing doctors and nurses to exercise their prejudices

Professor Shah Ebrahim, University of Bristol

Professor Ebrahim also quotes evidences from the US that doctors are more likely to issue "do not resuscitate" (DNR) orders for patients who are black, alcoholic, non-English speakers or who have HIV.

Professor Ebrahim told BBC News Online that research was needed to find out if similar discrimination was a problem in the UK.

He said: "Evidence for similar behaviour among British doctors is not available but the ways in which do not resuscitate orders are used in these potentially prejudiced groups merits research here."

Age Concern claims

Jill Baker and husband
Jill Baker was the subject of a DNR order
The charity Age Concern earlier this month claimed to have evidence that UK doctors were increasingly deciding not to resuscitate seriously ill elderly patients.

It highlighted the case of 67-year-old cancer patient Jill Baker, who spotted a DNR order on her own medical notes after she was admitted for treatment at St Mary's Hospital, Portsmouth.

Professor Ebrahim says that the UK experience proves that audit and education over the past 30 years has done little to stem prejudice against the elderly.

"Medical students still rejoice in their stereotypes of geriatric crumble and GOMER (get out of my emergency room) patients," he said.

"It is most unfair for age to be used as a criterion to withhold cardiopulmonary resuscitation."

Professor Ebrahim said legislation outlawing the practice of issuing DNRs is probably the only effective way to tackle the problem.

He said: "At present reverence for clinical freedom is simply allowing doctors and nurses to exercise their prejudices in the use of our health care resources, and results in unfair decisions.

"Legislation should result in improved quality of care by safeguarding the needs of the most vulnerable."

According to Professor Ebrahim, resuscitation after the heart and lungs stop working is successful one in five times.

DNR patients are 30 times more likely to die than other patients, regardless of the severity of their illness or other risk factors.

National guidance

The Department of Health is to publish national guidance on the elderly care next year.

Age Concern wants the government to hold a national inquiry into the treatment of elderly people, including the use of DNRs.

Campaigns manager Caroline Gilchrist told BBC News Online: "We believe an inquiry will convince the government that legislation is the only way to put a stop to this practice and to send a clear message to those in the health service that it is unacceptable to take this type of decision without the awareness of the patient or their relatives."

Dr Michael Wilks, chairman of the British Medical Association's ethics committee, said: "We are concerned about the issues of age and inequality in the care of elderly people in the NHS, but we reject any implication that doctors are withdrawing or withholding care on the grounds of ageism."

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See also:

13 Apr 00 | Health
NHS ageism row sparks action
08 Nov 99 | Health
Elderly attack 'NHS ageism'
30 Jul 99 | Health
Elderly 'denied cancer care'
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