Author Topic: Writing the rule book  (Read 994 times)

SallyintNorth

  • Joined Feb 2011
  • Far North West of England
  • Rarely short of an opinion but I mean well
Re: Writing the rule book
« Reply #15 on: September 06, 2011, 09:54:50 am »
Sorry for your loss Annie  :bouquet:

But as you say, by far the best way to go.  My father's mum died in an armchair with a duster in her hand and a smile on her face.  She was far too young to go but at least she knew nothing about it and was happy.

Don't listen to the money men - they know the price of everything and the value of nothing

Fleecewife

  • Joined May 2010
  • South Lanarkshire
    • Wester Gladstone Hebridean Sheep
Re: Writing the rule book
« Reply #16 on: September 06, 2011, 11:34:16 am »
I suspect that the relatives concerned were angry because they had not been consulted about the DNR. I am a great believer in informed consent, but I wonder how often the 'informed' part is truly informed. It is difficult to get the whole family together, plus the patient, plus the appropriate medics and to have a rational discussion where everyone agrees on the decision reached.  Ideally the patient should be the one to make the decision but it can often be impossible for someone to tell their relatives that they have decided they don't want to be resuscitated - and for all their relatives to agree with them - emotions run too high.
Many years ago I had a huge bust-up with a consultant who tried to make nursing staff give a patient 'too much diamorph' - his justification was that she was 95 and had a nastily fractured knee.  She had had surgery in the night and he found her slightly confused afterwards, when he woke her from sleep - wouldn't we all be.  However, she was as bright as a button once she had woken fully, she lived alone and was active and independant.  Nurses don't just blindly do what they are told, so she didn't get the excess analgesia, but sufficient to keep her comfortable, and a few months later she returned home fully recovered.
On the other hand it is sometimes the case that the amount of analgesia required to keep a patient comfortable is also a dose under which they will slip away - this is what happened with my father and he and we were all happy with that.
That is slightly different from an actual DNR where active measures to resuscitate a patient using CPR are formally noted not to be started.  If I had made such a decision about myself I would be furious if I was then resuscitated, but if someone had taken that decision for me without consulting me or my family I would be equally furious and it would be wrong, no matter what criteria they had used.  The situation is very different from euthanasia of an animal, where they are unable to choose for themselves, or even know what is in store for them - then it is our responsibility to take the decision for them.  But with a human being, no-one has the right to take their decision for them for so long as they have enough brain to decide for themselves - neither a broken neck nor terminal lung cancer would of themselves stop the patient at Addenbrookes from making the decision herself.

I agree also that there can never be a rule book which would cover every eventuality.  Each case should be judged on its own merits and every single patient should be treated as an individual with their own thoughts and reasonings on whether or not they are ready to die.


You will have seen the news report that a family is suing Addenbrookes Hospital over the death of one of their number.  Apparently a Do Not Resuscitate note was made on the file and the family objected.  I don't know the facts and it's all sub judice now but the odd thing was the quote by a relative

"We believe mum's experience is a consequence of a lack of clear policy on decisions relating to end-of-life care.  A clear and national policy is needed.  It should not be the case that there is a different policy from area to area.  This just does not make any sense"

Now her mother entered hospital with terminal lung cancer but also with a broken neck as a result of a road accident.  She died 16 days later.

How many people enter hospital in the UK with that combination of problems each year?  Or to put it another way how long would the policy document have to be to provide guidance for every life-threatening situation?  Are we not trying to take hugely subjective matters and codify them?  Should we not leave these things in the hands of those who have the clinical knowledge and experience to decide.  Someone's death is never going to be much fun, after all


« Last Edit: September 06, 2011, 11:42:36 am by Fleecewife »
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SallyintNorth

  • Joined Feb 2011
  • Far North West of England
  • Rarely short of an opinion but I mean well
Re: Writing the rule book
« Reply #17 on: September 06, 2011, 02:16:17 pm »
100% agree with everything you say, fleecewife
Don't listen to the money men - they know the price of everything and the value of nothing

ShaunP

  • Joined Dec 2009
    • Timber Chalets and Lodges
Re: Writing the rule book
« Reply #18 on: September 07, 2011, 07:29:32 pm »
I have recently lost my step father. He had been very ill since Xmas last year and when he was admitted into hospital 24 hours before he died the nursing staff discussed a DNR with my mother and sister who was also consented by him regarding his medical care.

As far as I am aware the medical profession are under hippocratic oath to provide the best care for there patient. It would be against medical ethics not to attempt resurcitation unless the patient, or there legal next of kin in the event the patient is unable to give consent had agreed to a DNR.

Several years ago, a very close friend was on life support after a short and sudden illness. The doctors where very professional in dealing with the issue of terminating treatment. It was the hardest day of my life when the family asked me to tell the docotors to turn off the machine. After he died, I made a point of telling my children that should I ever be in the same situation........turn it off!!!!   

 

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