Sometimes you have to read a press story several times to unpick the gist of it.
An article headed ‘Death wish databases spark fears elderly will be left to die’ had been on my desk for a few weeks, waiting to be read again, and then again, to make sure that I had understood what it was saying. Because I couldn’t believe it the first time.
District nurses’ visits
Last September elderly and disabled people in England were being visited by district nurses with questionnaires looking for answers such as ‘Where would you like to die?’ and ‘Would you want to be resuscitated in a crisis?’. One of my blog readers emailed to tell me that it wasn’t just the elderly who were being targeted. Her disabled son had also been visited and questioned.
Now the NHS is urging GPs to draw up end-of-life plans for those over 75, as well as vulnerable younger patients. GPs must ask them whether they want to be resuscitated in certain circumstances. Practice nurses are cold-calling patients to ask them.
One of hospital doctor Max Pemberton’s elderly patients was called out of the blue by his GP asking him to go in to discuss resuscitation. Dr Pemberton wrote: ‘The patient assumed his GP was attempting to tell him something was wrong – why else would she be talking about death and terminal illness with him when he had been at yoga only hours earlier? Both he and his wife called me asking if I knew how long he had left. I had to reassure them the GP was undertaking nothing more than a box-ticking exercise.’
He added: ‘Can anyone in their right mind really think that it helps to cold-call patients, many of whom are perfectly healthy, to ask them whether they want to die if they fall ill?’
Accessible information
Now there’s news that this personal information will go into a huge IT database, accessible by GPs, hospital staff and ambulance crews. The aim is to reduce the number of patients being taken to hospital for ‘unnecessary’ reasons. It’s been estimated that use of ‘electronic palliative care co-ordination schemes’ could save the NHS £50 million a year. I haven’t seen a full description yet of an ‘electronic palliative care coordination scheme.’
Two questions
It raises two huge questions. The first is – how can you predict right now whether or not you will have a crisis that could, or could not, be resolved by a medical intervention? It’s something that concerns Dr Tony Cole, chairman of the Medical Ethic Alliance, who said: ‘A patient nearing the end of life may have a treatable condition which could be relieved. People making their own end of life plans may not foresee this.’
The second is – are we going to have a system where ambulance crews access the database and, reading that the person’s preference is to die at home, make the decision not to take them to hospital? Do they have the clinical training to judge whether a person is dying, or whether an intervention would make a vital difference?
Very worrying
Neurologist Professor Patrick Pullicino said the concept of pre-determined electronic registers was very worrying. ‘Even though a patient may state that their preferred place of dying is at home, if they develop an acute emergency, they should not be denied admission to hospital for assessment’, he said.
One of our home managers told me about a resident who had a health crisis several times. On one occasion she called for an ambulance, and as the paramedics were taking the lady out on a stretcher they said they thought she might die before they reached the hospital. ‘Bring her back in then!’ said the manager, ‘If she’s going to die we’d rather have her here.’ The paramedics were surprised because that’s not what they were usually told.
Disposable cast-aways
Going to be with the Lord is precious in our care homes: it’s a holy time. But, if someone needs an intervention only a hospital can give, we want them to have it. We need to pray that older people will not be seen as disposable cast-aways, not worthy of medical attention.
