The Times
April 14 2000

Patients demand 'living wills' to protect elderly


PATIENTS yesterday called for "living wills" in all hospitals to stop doctors leaving old people to die.

The illicit practice of doctors writing "do not resuscitate" on the medical notes of old people, without first seeking their views, is endemic in the NHS, according to patients' organisations. The believe the Government should launch an investigation to assess the extent of the practice, and adopt American-style "living will" consent forms.

Age Concern said this would help to end the fear that many elderly people have of being "written off" by doctors who believe they are too old to have a good quality of life.

Beginning a campaign against age discrimination in the NHS, they have received nearly 100 "distressing" calls from elderly patients. "It is frightening to think how widespread this practice is," an Age Concern spokeswoman said.

"The Government needs to start a thorough investigation. How can they now ignore what people are saying?"

Cases included a woman in Nottingham who accidentally discovered "not for resuscitation" on her father's notes when he went into hospital at Christmas, and was told by nurses that this was standard procedure. "She was shocked and horrified by the blasť way they dealt with it," the spokeswoman said.

She said another man's mother went into hospital after a minor stroke. Although she had a good range of movement, she was 96 and told her son that doctors had pressured her for consent not to resuscitate if she had another stroke. They then tried to pressure her son and when he disagreed they put it on her notes anyway. She went on to enjoy 18 months of good-quality life.

Dr Sheila Adam, the Deputy Chief Medical Officer, said that it was against British Medical Association guidelines for doctors to order that patients should not be resuscitated without discussing the issue with patient or relatives.

Dr Adam said the people who had contacted Age Concern were "individual cases".

Julia Quenzler, co-founder of SOS NHS Patients In Danger, said she had received several hundred calls from patients and relatives about "DNR" (do not resuscitate) in the six months since her organisation was set up. "When the truth comes out this could be the greatest scandal in NHS history," Mrs Quenzler said.

"It is endemic in the NHS, and I believe far more sinister than it first appears. The words DNR act as a kind of code not to give patients the best treatment. This is horrific and cruel."

Joyce Robbins, co-director of Patient Concern, called on the Government to adopt the "living wills" used in America, where for the past nine years any patient entering hospital has been asked to register their views on resuscitation.

In the meantime, old people or their relatives should be vigilant and exert their right to see medical notes, she said. They should then challenge remarks such as "DNR", "not for fives" or "NFR" which tell medical staff not to resuscitate after a heart attack or stroke.

"The extent of this is disgraceful and there is absolutely no excuse for it," Mrs Robbins said.

Michael Wilks, chairman of the BMA ethics committee, said there was no sanction against doctors who ignored their guidelines. However, patients could complain to the General Medical Council if a doctor had not involved patients or relatives in discussions about resuscitation. In many cases junior doctors were delegated by consultants to carry out the sensitive task, and did not feel able bring the matter up.

Doctors were ultimately allowed to overrule the views of patients on the issue, he said.