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Last Updated:  Monday, 24 February, 2003, 12:48 GMT
Patients to decide treatment end
A nurse treats a patient at Hammersmith Hospital
Patients wanted to die free of pain
A London hospital is to ask patients to write a 'living will' which would tell doctors when to stop treatment if they become so ill they could not express their wishes.

The Hammersmith Hospitals NHS Trust, in west London, will give elderly patients a form called an Expression of Wishes in Healthcare.

It will ask them to imagine a number of medical scenarios such as if they had cancer, advanced dementia, were bed-bound by a stroke, doubly incontinent, blind, or confined to a wheelchair.

For every condition they will be asked to choose whether to accept or refuse life-prolonging treatments including being placed on a ventilator, having invasive surgery, artificial feeding by a tube into the stomach or being placed on a drip.

These written wishes will inform future treatment decisions and over-ride any opinions of the patient's family.

The move follows a study of 74 healthy elderly patients which showed that if they were dying:

  • 94% would prefer to refuse surgery
  • 93% did not want artificial feeding
  • 92% did not want to be placed on a ventilator
  • 90% did not want to be resuscitated
  • Women were twice as likely as men not to want treatment

Most of those questioned said they would prefer to be kept warm, comfortable and free of pain as they die.

The trust intends to hand out the forms to patients who are about to leave hospital so that they can take them home and discuss them with their families.

Trained nurses will explain the implications of their choices.

The forms have to be signed in the presence of a witness and are then kept with the medical notes.

Patient involvement

The form will also ask elderly people where they would like to die and whether they would like to appoint someone to make healthcare decisions for them while they are incapacitated.

"The intention is for patients to be much more involved in decision-making," said a spokesman for the trust.

"We are exploring projects that allow patients greater involvement in the future direction of their care."

Under UK law, doctors are not permitted to end a patient's life, but patients have the right to refuse treatment that would keep them alive.



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