‘Do not resuscitate’ policy amended

Dr Matt Cody agreed to amend the Trust’s Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy after a meeting of the Western Trust board.

The Consultant Anaesthetist and Chair of the Trust’s Resuscitation Committee presented the local health authority’s CPR policy to the board in December.

The document is designed to give guidance on when and when not to initiate resuscitation in the event of heart attack or stroke.

It’s designed to ensure good resuscitation planning so that there is timely and effective treatment to make it less likely that critically ill patients will deteriorate to the point of cardiac arrest.

According to the latest UK-wide data 16.6 per cent of patients survive to discharge after a cardiac arrest. But the Trust’s resuscitation policy places the power of life and death in doctors’ hands.

Provision is made for a DNACPR stance and it is stated that it is “the ward/department manager’s responsibility to ensure that all staff involved in patient care should be familiar with the existing DNAR Policies.”

According to the General Medical Council (GMC) a management plan needs to be established by every health authority to ensure patients’ wishes and preferences about treatment can be taken into account and that, if appropriate, a DNACPR decision is made and recorded.

The move to amend the policy followed a call by Trust Board member and Non-Executive Director Brendan McCarthy that the term ‘quality of life’ should accord with definitions used by the Scottish government and the World Health Organisation (WHO).

Mr McCarthy said that “while he supported the policy he had one area of concern regarding the use of the term ‘quality of life’ which is used within the policy without definition.

“He referred to literature published by the Scottish government and the World Health Organisation and suggested their definitions of ‘quality of life’ could be added as he believed it would strengthen the policy document.”

According to the Scottish literature the clinical decision to save a patient’s life should be taken if there is chance of successfully resuscitating breathing and circulation. However, doctor’s should not make any judgement about ‘quality of life.’

The Scottish policy is clear: “The role of the clinical team is to decide if CPR is realistically likely to have a medically successful outcome (sustainable breathing and circulation). Such decisions do not involve quality of life judgements.”

In Scotland clinical decisions “should be based on immediate health needs, and not on a professional’s opinion on quality of life.”

“This is primarily because opinions on quality of life made by health professionals are very subjective and often at variance with the views of the patient and relevant others,” the policy declares.

Following discussion of the Western Trust Board in December “Dr Cody agreed to amend the policy to reflect Mr McCarthy’s proposed changes. Subject to these changes members approved the policy.”

A spokesperson for the Western Trust told the Sentinel: “In the context of this policy when considering resuscitation status ‘Quality of life is defined as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.’

“It is a multidimensional concept which involves the individual’s perception of their life style within a cultural, social, environmental context along with other relevant aspects of their life such as physical health, psychological state and personal beliefs. (World Health Organisation Quality of Life, 1995).”