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| End of Life Decisions ‘made by patients’. |
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Never in the field of human endeavour can there have been such a crass policy. Think about it. Some one has called 999. We don’t know who. How should we react? If the dying person has a known terminal illness, and is dying at home, we may presume that the actors, relatives, general practitioner, hospice staff, carers etc., know this. So Advanced Directive or not discussions will have been held to explain the signs of death and the procedures to follow when the person dies.
How fast would you travel to the scene if you were told the person wanted to die? Human nature, teaches us. ‘If that’s what they want; why should we rush? Risking our lives and the lives of others rushing to the scene. Yet life and death decisions are not as simple as that. What if the emergency was life threatening, but not terminal, for example, choking on food, carbon monoxide poisoning, bleeding to death, etc. What then? If a doctor had not recently been involved, a Coroner’s inquest and a post mortem will be necessary. Shades of Shipman: not death by poisoning, but death by neglect. So whatever else happened, paramedics must never be told that there is an Advance Directive until they have arrived at the scene, and after they have made their expert judgement. For the scenario described of the relatives refusing, implies that the tolerance of the caring network has collapsed. And that’s a different problem, which will only be resolved when the UK government grasps the nettle of the ageing population and plans accordingly. Peter H Millard MD, PhD, FRCP Emeritus Professor, Geriatrics, St. George's University of London |
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