Should patients have a final choice over life and death? Do doctors ultimately know best when life sustaining treatment is futile?
End of life decisions and ‘do not resuscitate orders’ have been the subject of significant debate over the years. Thousands of do not resuscitate orders are added to medical notes each year. While the Department of Health has issued nationwide guidance, the NHS leaves if to individual Trusts to draw up their own policies and protocols relating to such orders.
Mr David Tracey has recently lodged judicial review proceedings against Cambridge University Hospitals NHS Trust and the Department of Health which are likely to re open the debate on end of life decisions.
The case relates to Mr Tracey’s wife who had recently been diagnosed with terminal lung cancer. She was admitted to Addenbrooke’sHospitalafter breaking her neck in a car accident and died sixteen days later. Mrs Tracey had capacity when she died.
Mr Tracey alleges that the doctors at Addenbrooke’sHospitalon two occasions put do not resuscitation orders in his wife’s medical notes. They cancelled the first one after his wife objected however they put the second one in place three days later without her consent or any discussion with her. Mr Tracey claims that his wife had full capacity and said that the lack of standard policy created a system that is “arbitrary, variable between hospitals and open to abuse”. He believes that in his wife’s case the Trust failed to offer a minimum degree of protection of her human rights.
Mr Tracey further alleges that the Trust acted illegally by not having appropriate policy on resuscitation decisions and the health minister failed to issue clear policy or guidance which tell patients and their families of their rights and legitimate expectations.
The solicitors acting for Mr Tracey maintain the view that the current system is open to abuse and can disregard patient choice. They say that the fact that life sustaining treatment can be withheld in a patient with full capacity without their consent or knowledge raises a real risk of violating individuals’ human rights.
It goes without saying that end of life decisions are particularly difficult and emotional decisions for patients and families to consider objectively. For that reason clinical judgement from a reasonable competent clinician is vital at this time. Arguably a nationwide policy which ensures that clinicians work with patients with full capacity and their families to fully inform them of their rights and legitimate expectations is long overdue. At Mayo Wynne Baxter we will be following this case with interest.
By Katy Meade
