Human Exceptionalism

Telling Paramedics Not to Resuscitate Dying Patients in the UK: Okay with SHS

The UK is permitting terminally ill patients to be listed on a register so that they are not resuscitated by paramedics in the event of a medical emergency. From the story:

Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die.

It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their ‘death wishes’ in advance. It is believed to be the first in the country, but other trusts around the country are expected to follow suit to comply with Government guidelines which state that patients’ wishes should be taken into account, even at the point of death.

Similar plans exist here in the USA, and I’m not opposed to them, assuming proper administration. The problem with the story is how it is framed. It isn’t a “death wish,” it is refusing unwanted medical treatment as part of an end of life plan of care.

When I was a hospice volunteer, I was explicitly trained to deal with such a situation (which never happened on my watch). If a patient went into a cardiac or other life-threatening event, I was explicitly told not to call 911, but rather, to phone the hospice nurse immediately so she could get there ASAP to ensure proper symptom management. In fact, we always had the hospice number with us just in case of such an event.

But sometimes people panic in the face of sudden medical events and call an ambulance when they shouldn’t. Refusing a paramedic CPR when the decision was taken in advance to sign a hospice or other DNR makes sense. But the actual DNR or a listing in a data bank also should be required. Otherwise, when an ambulance is called, the patient should be saved.

A pro lifer in the story worries that the the principle could be extended to the suicidal or people who are not terminally ill. That’s a different kettle of fish. But in this instance, setting up a data base to ensure that registered dying patients do not receive unwanted CPR is consistent with the hospice philosophy and proper end-of-life medical care.

Also, I’m not sure where the head line came from about letting “accident victims die.” I wonder if the headline writer actually read the story.

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