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I agree; there is often a misunderstanding of what resuscitation is. OK; 
you come into the ED in asystole - you probably won't get resuscitated 
anyway. But you go into VF in front of the doctor? You have a torrential 
GI bleed and need fluid (resuscitation) and lansoprazole? You develop a 
chest infection and go into type 2 respiratory failure?

I have not accepted these in the past unless the individual concerned 
has given clear instructions on what they do or do not want and under 
what circumstances in discussion with a doctor who understands both what 
we can do and what we won't do. they can have it signed by as many 
solicitors as they like. The ones that really bother me are from people 
with mental health problems, as you can never be sure they have 
capacity. The most successful in our experience have been the patients 
with large aneurysms that are too frail for surgery or refused it; we 
keep the letters from the vascular surgeon and if one comes in we keep 
the patient comfortable. 

> 
> Does anyone on the list accept advance directives from patients "in
> advance" - ie scan them onto the system and flag them as a special 
> case
> prior to their arrival? we have been asked if we can do it, and I am
> concerned that to accept the advance directive and undertake to scan 
> it
> in suggests that we will be able to guarantee we won't start resus 
> and I
> am not sure that is possible
> 
> what do others think?
> 
> Ruth
> 
> 
> 
> --
> *Included Files:*
> am2file:001-HTML_Message.html


/Rowley./