Turning the current 'Do not Resuscitate' process in hospitals upside down by using a Universal Form of Treatment Options (UTFO), enables hospital staff to actually be focusing on whether their goal is active treatment or optimal supportive care and could result in a 46% reduction in harm to patients, argues Zoe Fritz, consultant physician at Cambridge University Hospital and a Wellcome fellow in bioethics.
"In Australia the hospital directive is NFR – Not for resuscitation. In the UK it is DNAR – No not attempt resuscitation, or DNACPR - Do not attempt cardiopulmonary resuscitation. Physician and bioethicist Zoe Fritz has looked at the affects of these end of life directives and says while the aim is laudable, current practice is problematic and unethical. She found some patients with DNACPRs were being left and sometimes not receiving active treatment for non life threatening conditions. A new system and cultural change in some hospitals has found a 46% reduction in harm to patients."
An application for a £2 million grant to do a cluster randomised trial to verify the findings was turned down, but a website ufto.org has been maintaining interest in this alternative approach.
As patients, we can't change the system, but reading/listening to this Australian National Science Show interview that was broadcast in early April, might just encourage us to raise this subject with our doctors, rather than leaving it to them to decide for us...
Neil
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Thanks for this, Neil. I think it covers some extremely important issues. It can be all too easy for doctors and nurses to look at patients labelled as DNR (or equivalent acronym), and think of them in a different way to others - thinking that it's not worth giving them treatments for other ailments, or not seeing their care as important.
Anything that will change these attitudes, seems good to me...
Just because a person may decide he or she doesn't want cardiopulmonary resuscitation, or certain intrusive treatments, doesn't mean they don't want antibiotics if they have an infection, or medications to ease other symptoms.
A couple of days ago, my father-in-law (aged 91) was asked by a doctor, if he'd like to discuss "End of life plans". It was a surprise to him, but he's thinking about it. He's had repeated complicated health problems, and frequent hospital admissions, these last few months. Treatments have helped him to some extent, but there is a limit to what can be done for him. I'm hoping that he and my mother-in-law will talk these things over with the family, as well as with the doctor.
It was only a few weeks ago, that my father-in-law was told it was not safe for him to drive any more. That was hard for him, because he'd been driving all his life, and still enjoyed it. He reluctantly accepted the end of his driving days, but said he would now like to get a mobility scooter!
Why was I surprised? I needed to examine my own attitudes there... Just because a man is 91 and not driving any more, doesn't mean he needs to give up on being mobile. We all want to make the most of our lives, for as long as we can...
So, thanks again for this link, Neil. Certainly well worth reading (I read the transcript).
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