Pain, suffering and death are to some extent, inevitable in human life, though Health care must always seek to eliminate unnecessary suffering and untimely death. But it is easy to recognise that prolonging the process of dying us often undesirable. The difficulty encountered by medical teams is to establish and act accordingly to a general policy free from prejudices and subjective judgments. Failure of the cardiac and respiratory functions is part of dying; CPR can theoretically be attempted on every individual prior to death. But, from settings to settings, situation differs; sometimes it is not appropriate to prevent death to occur. A decision not to attempt resuscitation applies only to CPR; it does not imply "non treatment" and overall treatment and care that are appropriate for the patient will continue to be considered and offered. It is important to underline the difference of DNAR with other withdrawals of treatment because people can be misjudged about them:
As the law stands, assisted suicide and all similar processes whereby one person hastens another's death are illegal. Doctors and nurses can ensure that the patient is receiving enough pain relief to keep him comfortable; it is illegal for them to give him more than he needs with the intention of ending his life more quickly. The British Medical Association [BMA], in conjunction with the Royal College of Nursing [RCN] and the Resuscitation Council [UK] produced a first set of guidance on decisions relating to CPR in 1999, in order to offer a frame to the medical practitioners and to identify key ethical and legal issues . Less than two years after, in March 2001, the same organisms, edited an updated new set of guidelines, quite different.
[...] The assessment is made by the Consultant or the Specialist registrar in charge of the care of the patient. If any doubt arises, advice must be sought from mental health professionals. Doctors are responsible for deciding in best interest” of the incapacitated in general. No person is legally entitled to give consent on behalf of an incompetent adult. The involvement of close in the DNACPR decisions is welcome but must overall reflect the wishes of the patient, _ when there is no advance directive preventing them to intervene or to be disclosed confidential information_ . [...]
[...] But, from settings to settings, situation differs; sometimes it is not appropriate to prevent death to occur. A decision not to attempt resuscitation applies only to CPR; it does not imply treatment” and overall treatment and care that are appropriate for the patient will continue to be considered and offered[1]. Legal background It is important to underline the difference of DNAR with other withdrawals of treatment because people can be misjudged about them: As the law stands, assisted suicide and all similar processes whereby one person hastens another's death are illegal. [...]
[...] An advance decision that CPR will not be performed is required to be made after the consideration of several aspects of the patient's condition. The guidelines in section 3 specify that the first of these aspects is the “likely clinical outcome, including the likelihood of successfully restarting the patient's heart and breathing and overall benefit achieved from a successful resuscitation”. This assertion directly implies that evaluation of the interest to attempt CPR must be made by the medical team: - if there is a real chance that this restarts the ceased functions, - and if it is in the best interest of the patient. [...]
[...] Kevin Stewart, Claire Spice, GS Rai. Age and Ageing 2003; 32: 143-148 Where now with Do Not Attempt Resuscitation Decisions. Anne Morris. pp3 Easing the Passing: End Of Life Decisions and Medical Treatment {Prevention of Euthanasia} Bill: Med Law Review {3001} Report of the House of Lords Select Committee on Medical Ethics, HL. Paper 21.2 {HMSO1994} at para 264 Re T {Adult: Refusal of Treatment} [1992] 4 All ER 649 Re C {Adult : Refusal of Treatment} [1994] 1 All ER 819 Airedale NHS Trust v Bland [1993] 1 All ER 812 JK Mason, RA MacCall Smith, GT Laurie. [...]
[...] On the contrary when no proxy has been appointed, the Act recognises on a statutory footing the authority of the doctors to do what is reasonable in the circumstances to safeguard or promote an incapacitated patient's physical or mental health. But as in the rest of United Kingdom, proxy must be seen to be acting in the best interest of the patient or they may be open to legal challenge. The Children and the Young Persons The position of the guidelines as regards to children quite follows the same trends as for the incapacitated adult. The views of the children and young people must be taken into consideration in decisions about attempting resuscitation. [...]
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