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Independents' Day

We need a discussion about natural death

Dr Richard Cook

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I was once hauled out of afternoon surgery to drive round to the house of a patient in his 93rd year who had been found dead on the floor by his carer. What was the rush I hear you ask? Well, he had two burly paramedics attempting to resuscitate him, and they could not stop unless a doctor attended.

This was before the days of widespread use of DNAR forms, but coincided with an increasing interest in the legal issues surrounding death and who should be allowed to die in peace.

More recently I was asked to visit a nursing home one evening where an elderly patient had been admitted that day for palliative care. The reason for the visit? Not for any clinical deterioration, medication need or opportunity to discuss with the family, but just simply to complete a DNAR form as this had not been transferred from the hospital from where he had come.

You can imagine the conversation: ‘Hello Mr Jones, nice to meet you and sorry you are feeling a bit peaky. Have you seen this red bordered form before…?’

Let’s get patients to take control of their destiny

You can’t help feeling that we may have got things a bit wrong. There is no doubt that discussions around death and dying are really important, so let’s get patients to take control of their destiny. I suggest an overhaul of the system.

As a starter for 10, what about this: given the poor success rate, should we run an opt-in service for DNAR (a bit like organ donation at the moment)? Say from the age of 70, maybe 80? Nobody will have resuscitation attempted after this age unless they have completed an online process and consented to it. (I’m sure Capita could get this up and running in no time.)

For those that find this difficult – no problem, we all love an enhanced service, so people could have specific discussions with their GP and the relevant template completed, probably involving some sort of MDT/risk reduction/docobo/avoiding admission/death type meeting, with quarterly reports to be rubberstamped by the CCG and the top and bottom 5% of practices being singled out for interrogation.

This would put patients in control and promote a public debate, ensuring that the pros, cons and success rates of resuscitation would be widely understood – meaning everyone’s a winner.

For those cynics out there, we could even put the idea out to the public for a vote – a referendum if you will – where the options are: ‘Yes, I would like to be allowed to die a natural death after I reach three score years and 10,’ or ‘Yes, I would like to be allowed to die a natural death after I reach three score years and 10, but only after somebody has jumped up and down on my chest.’

What do you think? If nothing else, a fresh referendum would keep many people happy and no doubt stimulate refreshing and insightful discourse such as: ‘I would like to die but still hold on to some of the benefits of life, like breathing,’ or ‘Death means death, there can be no going back’.

I’m off for lie down while you discuss it - I sleep quite heavily, but I’m not 70 yet...

Dr Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate


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Readers' comments (6)

  • Like the author, I am in favour of any scheme that has lots of badly designed forms to fill in, preferably urgently. Perhaps the RCGP could include this as an “Extended Role” and thus generate a separate annual appraisal.

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  • David Banner

    The only thing that died a natural death in recent years was common sense. Before these ludicrous unnecessary DNR forms, the terminally ill simply died. Yes, the odd litigation obsessed nurse/paramedic shattered ribs and their reputation on pointless CPR, but usually common sense prevailed.

    But now?? No form, no death allowed. GPs dragged out to bewildered punters to tell them they aren’t CPR worthy. Anxious DNurses panicking that there is no form in place, that they will HAVE to perform CPR on a hapless centenarian if you don’t pull your finger out.

    The system doesn’t need replacing, it needs scrapping.

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  • I gave a talk recently at one of the residential units we cover. I explained exactly what a DNR form is and what it is not.
    Since then we have had lots of residents asking for forms at the surgery.
    If people are made aware that DNR means just and ONLY that and it does not mean they will not be treated as usual for all other conditions, there is no problem.

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  • I think a general education of the public of the success rate and possible complications of resuscitation would be useful. I think people tend to believe it’s always successful. I don’t think an arbitrary age is appropriate as there is such diversity in how fit people are at 70 and even 80. It never ceases to amaze me when I ask people about their wishes how polarised views are so I think it is important to ask. I also think certainly hospital medics tend to do fewer other treatments if the form is signed - there is often a bit of a shrug and a ‘ they’ve got a purple form’ attitude and I think that is wrong. Personally I think maybe an opt in form for anyone in a nursing or residential home might be a start and certainly no one on a palliative care register should have one.

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  • I'm all for putting more defibrillators in remote red telephone boxes to brighten them up a bit. The old folks in my village think its a great idea too - its replaced the maypole as a pagan symbol of longevity, and provides endless debate at village meetings which is good for their dementia.
    (I calculated that it might be successfully used once every hundred years)

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  • 758 pm
    Nicolaus, Your Maths is probably out by a factor of 2 at least. Make it 200 years, by the time we would have sorted the theory of everything.

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