Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T12:07:30.235Z Has data issue: false hasContentIssue false

‘Do not resuscitate’ decisions – need for objective measures

Published online by Cambridge University Press:  02 January 2018

David Cornelius*
Affiliation:
Staff Grade in Old Age Psychiatry, Whitchurch Hospital, Park Road, Cardiff CF14 7XB, email: davycorn@yahoo.com
Rights & Permissions [Opens in a new window]

Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2007

Chakraborty & Creaney (Psychiatric Bulletin, October 2006, 30, 376–378) described the understanding of ‘do not resuscitate’ (DNR) orders among staff in continuing care psychiatric wards. Many nursing staff and many psychiatric trainees connect DNR orders not only with cardiopulmonary resuscitation (CPR) but also with the intensity of medical intervention for physical illness. Deterioration of physical health is more common than cardiac arrest on old age continuing care psychiatric wards and requires a decision on whether or not to transfer to a medical facility. In the absence of clear guidelines, the role of DNR orders is debatable.

The argument for a DNR order is clear. In advanced dementia complicated by physical debilitation, CPR is unlikely to be successful. If successful, residual brain damage worsens the prognosis, contributing to an even poorer quality of life. Such information is understood by relatives. However, reasons given for not transferring to a medical ward appear vague and at worst inhumane to relatives. A common explanation from a medical registrar on duty is that further intervention is unlikely to improve quality of life. This is viewed by many relatives as evidence of ageism in an era of scarce resources. Indeed, transferring such patients may improve their quality of life by relieving pain and discomfort caused by reversible conditions such as pneumonia, septicaemia and bowel obstruction.

Perhaps the answer lies with clear and transparent guidelines supported by objective means of measuring quality of life. Old age psychiatrists need training in palliative care so that they can justify their treatment choices in those with terminal illness.

Submit a response

eLetters

No eLetters have been published for this article.