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Last Updated: Wednesday, 28 June 2006, 14:46 GMT 15:46 UK
'Living wills' fears for doctors
Anaesthetists prepare patients for surgery
A law change allowing patients to make "living wills" could leave doctors open to accusations of euthanasia, two Belfast anaesthetists have said.

The Mental Capacity Act will give legal recognition to a patient's right to make advance decisions about treatment.

Anaesthetists fear they may be compelled to honour instructions not to resuscitate in dangerous circumstances.

Two doctors at the Royal Victoria Hospital said urgent guidance was needed on resusitation orders.

Dr Michael McBrien and Dr Gary Heyburn made the comments in an editorial in the July issue of Anaethesia, the official journal of the Association of Anaesthetists of Great Britain and Ireland.

From 1 April 2007, the Mental Capacity Act will give formal legal recognition to the patient's right to make advance decisions about the care they receive and reinforce the common law position about DNAR (Do Not Attempt Resusitation) Orders that already exists.

"The paternalistic primary ethical principal of the past, namely immediate medical benefit to the patient, has been overtaken," Dr McBrien said.

"If we are not to face litigation in the future we must read, understand and implement what the law requires from us in this area."

Patients who have surgery often need routine interventions while under anaesthetic that could be regarded as resuscitation, said Dr McBrien.

The two doctors are based at the Royal Victoria Hospital
The two doctors are based at the Royal Victoria Hospital

But automatically suspending a DNAR order during surgery may in future no longer be an option.

On the other hand, sticking to the letter of an instruction not to resuscitate could result in a patient's death.

"If the anaesthetist were to proceed and strictly obey the general understanding of a DNAR order under such circumstances, it could possibly be construed as an act of euthanasia or assisted suicide," the doctors wrote in the editorial.

The doctors said clinicians also needed clear guidance about how to handle requests made by the parents of sick children or relatives of patients not thought to be legally competent.

Under the act, patients with conditions such as Alzheimer's will be able to empower friends or relatives to make decisions on their behalf should they become incapacitated.

"Usually agreement will be reached about whether cardiopulmonary resuscitation should be attempted if the patient suffers respiratory or cardiac arrest," said Dr McBrien.

'Child's interest'

"If disagreement persists despite attempts to reach agreement, legal advice should be sought.

"Parents cannot require doctors to provide treatment contrary to their professional judgement, but doctors will try to accommodate parents' wishes as far as is compatible with protecting the child's interest."

The Journal's editor-in-chief Dr David Bogod, consultant anaesthetist at Nottingham City Hospital said: "Dr McBrien and Dr Heyburn have done patients a service in stimulating discussion about the relationship between modern - and often quite complex - DNAR orders and the interventions required during anaesthesia.

"The issue actually extends to wider aspects of medical practice by anaesthetists, including intensive and palliative care.

"While individual autonomy in these cases is often best served by a sensitive and detailed exploration of the patient's wishes by the doctors caring for them, it might be that some national guidance is needed.

"The Council of the Association of Anaesthetists of Great Britain and Ireland have advised us that they are actively considering setting up a working party for this purpose."

Anaesthesia is published by the Association of Anaesthetists of Great Britain and Ireland.

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