Carlos wrote a piece in the EMJ for the SIMS series. It explains the
advanced directive and gives an example of the format such a document should
take.
Emerg Med J 2002;19;255-259 :
http://emj.bmjjournals.com/cgi/content/full/19/3/255
SIMS Article 8 Inbox :
http://emj.bmjjournals.com/cgi/content/full/19/3/255/DC1
I suppose, if you are really serious about a DNAR then make sure your family
know and then they won't call 999.
Simon McCormick
SpR Sheffield
P.S. Has anyone else noted the irony of the Leicester situation and the
fact that the FFAEM exam is being held there in 9 days!
----- Original Message -----
From: Goat <[log in to unmask]>
To: <[log in to unmask]>
Sent: 28 October 2002 19:19
Subject: Re: DO NOT RESUSCITATE!
> Quite right Adrian, but the hoops patients have to jump through to make
> an advanced directive binding, particularly in the field of emergency
> medicine, make them quite rare.
>
> I would certainly ignore a piece of paper, even if signed and apparently
> witnessed, stuck to a patient's chest with a DNAR directive on it. If a
> patient is serious about not wanting to be resuscitated then their
> wishes most certainly should be respected.
>
> However, my understanding of being "serious" about their treatment
> requires...
>
> Information (of accepted practice and alternatives if applicable) in a
> form the patient can comprehend,
> Capacity to weigh the information and come to a decision,
> The wish is sustained over time and subject to review (? how often),
> Specific details about what circumstances the directive applies to,
> No coercion (obviously)
>
> Best practice also dictates involvement of family, witnesses and a
> second senior opinion.
>
> In practice, this means that a patient who really doesn't want certain
> emergency treatment (resus or otherwise) is required to discuss their
> wishes at least twice in advance with at least 1 consultant in A&E,
> their GP, their relatives, +/- their solicitor, to lodge a formal
> witnessed statement specifying unambiguously what they do or don't want
> in the A&E department (and GPs surgery), and to be willing to have their
> decision ratified periodically. See what I mean about hoops. If they do
> all this, then treating them against their wishes would invite
> accusations of battery.
>
> I know of no patients at my unit who are that "serious". There must be
> docs out there who have patients on their books with valid ADs. I'm as
> interested as Gerry McArthy to know if the USA suit was succesful. I
> don't think it would have got very far in the U.K. There are also some
> medicolegal lawyers lurking I believe. Come on guys: give us your two
> penny-worth!
>
> Goat
>
>
>
>
> In article <[log in to unmask]>,
> [log in to unmask] writes
> >> from: "Dunn Matthew Dr.
> >> My understanding is that there is no specific legal status of a living
will
> >> regardless of its form.
> >
> >Not quite true Matt; while there is no statutory duty to comply with
advance
> >directives, the general principles have been endorsed by both the BMA and
> >Government. Thus you would be wide open to successful litigation if you
chose
> >to
> >ignore a bone-fide advance directive. This hasn't yet been tested in case
law
> >but the implications appear fairly clear to me, i.e. I would comply with
such a
> >directive.
> >
> >Adrian Fogarty
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
>
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