'Patients must decide on resuscitation'

Doctors are deciding not to resuscitate seriously ill elderly patients, says Age Concern

Doctors have called for US-style consent forms to be introduced to ensure patients agree before a decision is made not to resuscitate them.

In the US, patients are required to sign a Do Not Resuscitate (DNR) order when entering hospital if they do not wish to be resuscitated.

In Britain, doctors are recommended to seek the consent of patients before placing a DNR order on their medical notes or deciding not to resuscitate.

But doctors at the BMA annual conference have suggested that the current policy could be strengthened to require doctors to obtain the written consent of patients before placing DNR orders.

The matter has been referred to the BMA's medical ethics committee for a decision.

While the BMA recommends that doctors discuss the issue with patients, it is understood that many fail to.

Dr Michael Wilks: worried about junior doctors

Dr Alex Freeman, a GP in Southampton and a member of the GMC, highlighted the high-profile case of 67-year-old Jill Baker who had a DNR order written on her medical notes without her consent.

"She was understandably distressed by this as no discussion had taken place with her or her next of kin," Dr Freeman said.

She added that many doctors were failing to follow the BMA's guidelines on consent. She said uptake "left a lot to be desired".

Junior doctors taking decisions

Dr Freeman also criticised the fact that many junior doctors are being forced to make DNR decisions because senior doctors are unavailable.

"All too often these decisions are made by junior doctors at the request of nurses and sometimes in the middle of busy ward rounds.

"It is difficult to have discussions with patients about resuscitation but this is no reason why discussions should not take place.

"Maybe we need to move to a US-style system where patient's sign a DNR order."

The chairman of the BMA's medical ethics committee Dr Michael Wilks said he was aware that many junior doctors were being forced to make DNR decisions.

He said the BMA backed the call for consultants to play a much greater role in making these decisions and said junior doctors must never be coerced into signing DNR orders.

Dr Wilks told delegates that the BMA would initiate a public awareness campaign with the Royal College of Nurses to ensure patients knew what resuscitation involved.

He added that the issue of written consent for DNR orders would be considered by the committee.