The Accidental Smallholder Forum

Community => Coffee Lounge => Topic started by: waterhouse on August 29, 2011, 08:56:54 pm

Title: Writing the rule book
Post by: waterhouse on August 29, 2011, 08:56:54 pm
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

Title: Re: Writing the rule book
Post by: little blue on August 29, 2011, 09:13:51 pm
 a DNR is the patient's choice, surely it disregards the cause of hospitilisation.

I hope my wishes are respected when the time comes, both by family & hospital staff...
Title: Re: Writing the rule book
Post by: Hatty on August 29, 2011, 10:56:35 pm
DNR is not always the patients choice but is usually discussed with them as far as I know, my Dad died from terminal Lung Cancer 4 years ago and DNR was put on his notes by the consultant and I was glad. Towards the end I was asking if there was anyway they could give him to much morphine, and end things quicker, he collapsed in Turkey on holiday,spent 4 days in hospital there, flew home (cost us £15000 insurance wouldn't cover) and lasted just 10 days when we got him home, you wouldn't watch an animal suffer for that long it was awful, if she went quick they should think themselves lucky
Title: Re: Writing the rule book
Post by: knightquest on August 29, 2011, 11:06:03 pm
They're probably after the compensation - too cynical?

Ian
Title: Re: Writing the rule book
Post by: tizaala on August 30, 2011, 08:27:47 am
The way things are looking  now , as soon as you reach 65 and are likely to be claiming your pension the government will instigate a policy of involuntary euthanasia as you are no longer economically viable.
Title: Re: Writing the rule book
Post by: ellied on August 30, 2011, 08:32:58 am
My mum had a DNR on her notes at her request on the day she died, I was told afterwards..

Sadly as my older sister was listed next of kin and was expected at visiting time (and made it as mum was fading with 10 minutes to spare) I wasn't informed of her rapid decline and as a result was only told by phone when my sister arrived by which time it was too late for me to get there :(

I have to assume it really was mum that initiated or agreed to this, but it is one of the things that haunts me even now.

I know nothing of the court case in question so can't comment..
Title: Re: Writing the rule book
Post by: shetlandpaul on August 30, 2011, 08:44:27 am
it would be cruel and pointless to do cpr on a person who has late stage cancer. you would be causing them more pain and very likely causing them injury. cpr is not a gentle thing. if this lady had a broken kneck as well it would have made it even more dangerous. DNR is totally diffrent from not treating there condition. really its just the person dying from their condition. very sad but death can and is better than life sometimes. what the goal should be is a good death.
Title: Re: Writing the rule book
Post by: shearling on August 30, 2011, 09:21:32 am
More like 68 - I have just had my minimum pension age moved by the government and by the time I get there no doubt it will then be in the 70's

The way things are looking  now , as soon as you reach 65 and are likely to be claiming your pension the government will instigate a policy of involuntary euthanasia as you are no longer economically viable.
Title: Re: Writing the rule book
Post by: doganjo on August 30, 2011, 11:47:16 am
My mum had a DNR on her notes at her request on the day she died, I was told afterwards..

Sadly as my older sister was listed next of kin and was expected at visiting time (and made it as mum was fading with 10 minutes to spare) I wasn't informed of her rapid decline and as a result was only told by phone when my sister arrived by which time it was too late for me to get there :(

I have to assume it really was mum that initiated or agreed to this, but it is one of the things that haunts me even now.

Ellie, don't beat yourself up about it.  My Mum refused cancer treatment knowing exactly what she was doing.  Towards the end I was called, and stupidly went for my husband and son first. As a result by the time I got into the hospice she had just gone.  But I had said my goodbyes before I left, and my Aunt(the one that';s just died) and her daughter were there, and my sister arrived soon after. so she was well loved at the last.  I'm sure your Mum knew your love for her.
Title: Re: Writing the rule book
Post by: smallholder in the city on August 30, 2011, 12:47:41 pm
It's been a while since I had to do one but hospitals generally have their own guidelines but most advise a discussion with patient and family, whilst ultimately putting the responsibility for the final decision with the senior clinician, the consultant who can always request a second opinion if they want to. I think treating each case individually is more sensible than trying to legislate for everything.

And yes DNR does not mean don't treat, and CPR is not a pleasant thing to undergo.

I feel desperately sorry for the family who are clearly in the midst of grief and need something to hold onto /distract them from it, perhaps they weren't prepared for what happened (sometimes there just isn't time and sometimes people can't hear what they are being told) and perhaps someone neutral needs to spend time with them explaining that it's Ok to be angry but a court case won't bring her back.   

Title: Re: Writing the rule book
Post by: waterhouse on August 31, 2011, 12:27:52 am
My brother, who is a medic, was very upset when our mother died.  He talked of disputing the death certificate and didn't believe the hospital had done all they could.  But then he'd lived 200 mi away and OH and I had done all the visiting, mending things and fetching and carrying for the decade after dad died.  In her last few weeks something was going wrong but it wasn't showing in the innumerable blood tests.  She died just shy of 90 and was ready to go. I think she died of getting old, things were just not working properly, but apart from the last six hours she was in her own home.

I think anger and guilt turn up in these cases.  The peaceful end surrounded by a grieving family is a rarity, it seems.

Title: Re: Writing the rule book
Post by: Hatty on August 31, 2011, 08:36:49 am


I think anger and guilt turn up in these cases.  The peaceful end surrounded by a grieving family is a rarity, it seems.



My Dad died during the awful floods in 2007, couldn't have him home because the whole town was flooded (needed specialist equipment and they couldn't get it to us), I couldn't get home (live about 8miles away) so spent the last 7 days in a chair by his side, on my own! Mum visited a couple of times a day she lives just over the road from the hospital, he was never alone, only when he went to sleep did I go for a walk or down to theatres to watch telly/share a Chinese (BF staff nurse) I was there when he died a felt comforted by knowing I had been there for him, I know the hospital did all they could.in the circumstances, but other members of the family who couldn't get there tried making a fuss  ::) my Dad had only been retired 18months he was not old, I feel privileged I was able to be there for him, giving back a little for all the times he'd been there for me! I know I was lucky as not everyone can do what I did
Title: Re: Writing the rule book
Post by: mmu on September 05, 2011, 09:31:31 am
This is a very thought- provoking subject.  We often say "I hope I die before I get old" but there's nothing wrong with getting old, it's getting ill and old. that's the problem.  Surely if we choose our health professionals with more care, making sure that humanity was as high on their list of qualifications as their skills, and then left life or death decisions to them, getting old, being sick, and ultimately dying might become a far less frightening process for all involved.  We do, after all, have our animals put down before things get too bad for them, if at all possible, Even though it's sometimes a very difficult decision, it's our responsibility to take it, so surely, when people we love are dying it's best to let them go, however badly that affects us.
Title: Re: Writing the rule book
Post by: shetlandpaul on September 06, 2011, 08:07:54 am
easier said than done. a good death requires all the people involved in the care of the person knowing what is happening. we are lucky up here the gps are willing to care for the person at home. unless the person needs specialist care hospital is the wrong place to be.
Title: Re: Writing the rule book
Post by: doganjo on September 06, 2011, 09:52:43 am
My aunt died last Sunday morning.  In her own home, but as it happens she was alone at the time - however, the circumstances gave her the very absolute best death ever.  My uncle went for the Sunday papers leaving her eating her breakfast.  When he came home he found her sitting with the spoon of cereal in her mouth.  No disturbance, her heart had just stopped.  She was 85 and Uncle John is 88.  She had high blood pressure and a heart condition but was not expected to die anytime soon.  She also had a non aggressive form of breast cancer so we all are sad to have lost her but happy that she went before the cancer gave her any problems, and with no pain or suffering.  Goodbye Auntie Bel :'( :'( :'(
Title: Re: Writing the rule book
Post by: SallyintNorth 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.

Title: Re: Writing the rule book
Post by: Fleecewife 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


Title: Re: Writing the rule book
Post by: SallyintNorth on September 06, 2011, 02:16:17 pm
100% agree with everything you say, fleecewife
Title: Re: Writing the rule book
Post by: ShaunP 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!!!!