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Sunday, 21 May, 2000, 22:59 GMT 23:59 UK
Should doctors play God?

Doctors are accused of ignoring patient guidelines
Following controversial accusations that doctors are deciding not to resuscitate dying elderly patients, BBC Health Correspondent Kim Catcheside asks - Who is playing God?

Joyce Butterworth's husband Derek died in hospital in Portsmouth six months ago.

Because he was very ill, hospital staff had decided that he was unlikely to survive resuscitation if his heart failed.

The decision not to resuscitate him was put in a coded message on his notes which read "not for 555... wife understands".

The problem is that Joyce Butterworth says she was not consulted about the decision not to resuscitate her husband.

She is sure doctors had not discussed it with him either.

If so, hospital staff had ignored guidelines from the British Medical Association which say that "Do Not Resuscitate" decisions (DNR) should always be discussed with the patient, if they are competent, or the relatives.

Ethical concerns

More than 200 miles away in Derby, Margaret Hornell discovered a few days before her husband's death that a doctor had decided not to resuscitate him.

She too was not consulted.

Both women are devastated by the way these life and death decisions were taken.

It is an issue which has concerned the British Medical Association, BMA.

"A decision to resuscitate a patient or not depends largely on two things... the chance of success and the quality of life a patient is likely to be left with afterwards," said Dr Michael Wilkes, chairman of the BMA ethics committee.

He believes the guidelines on consultation may be widely ignored.

Success rates vary from 90% for someone who has had a heart attack to a fraction of one per cent for someone with terminal cancer.

It is where doctors are trying to judge someone's quality of life that DNR decisions become much more problematic, especially if that person is severely disabled.

Dr Rhani Pall, a consultant paediatrician, says life and death decisions in cases involving seriously ill or disabled children can be a lottery, depending on the individual prejudices of the doctors concerned.

This is why consultation is so important.

Doctors can only make a proper judgement about the quality of someone's life in discussion with patients and relatives.

Without openness there will always be suspicion that doctors are playing God.

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See also:

13 Apr 00 | Health
NHS ageism row sparks action
18 Apr 00 | Talking Point
Should doctors decide the time to die?
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