I’ve had quite a few hits recently on a post I wrote about the Liverpool Care Pathway plan. I wonder if it is because of reports about David Tracey suing Health Secretary Andrew Lansley and Addenbrooke’s Hospital, Cambridge following claims that staff at the hospital put “do not resuscitate” notices on his wife’s medical notes without the consent of her family.

It’s also a scenario that unfortunately is not uncommon, largely due to poor communication by  hospital staff. In the last few months of my father’s life, his tubes were removed from him when we popped out for a coffee without us being informed, and we had to ask for them to be replaced. When my mother-in-law was nearing her end, her doctor indicated to me that they would not resuscitate her if there were problems, and I told him to discuss this with her husband who, of course, wanted her life saved for as long as possible.

The Guardian’s report of the David Tracey case says:

David Tracey claims doctors at Addenbrooke’s hospital, Cambridge, twice put “do not resuscitate” orders in his wife’s medical notes, cancelling the first after she objected to it only to put in a second three days later without her consent or any discussion with her.

Tracey alleges the hospital’s actions deprived his 63-year-old wife Janet of the right to life and subjected her to degrading treatment, while he was denied respect for his personal and family life.

He is also seeking to force the coalition government to draw up a policy for England on the use of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) instructions, and claims the present system of local policies is open to abuse.

The case is likely to ignite a public debate over whether patients should have the final choice over their life and death, or whether doctors ultimately “know best” on when such treatment might be futile.

Louise describes her experience regarding her father’s stay in hospital which she wrote in a comment on my post about Liverpool Care Pathway:

Yesterday I telephoned the hospital where my father had been admitted suffering from an infection. In the morning he was stable and comfortable. Late afternoon I called again due to concerns expressed by my brother and spoke to a nurse to enquire about his treatment and illness. The nurse was vague about the infection so I threw in MRSA she defensively replied telling me he has sepsis. I was informed that death was imminent and he was receiving LCP. I’m unfamiliar with those initials so I asked the nurse to clarify and when she said Liverpool Care Pathway I knew precisely what was planned for him. I told her that this wasn’t treatment for sepsis but euthanasia and that we had not given our consent to this plan and that we opposed it and why wasn’t he being given intravenous antibiotics.

This afternoon my brother dropped in and learned that my father’s insulin had been returned and he was receiving antibiotics and this man (at death’s door according to the nurse) was drinking a cup of tea and was lucid and cheerful.
His partner claims she had no understanding of the implications of The Liverpool Care Pathway.

I suspect that if I hadn’t intervened and asked a few questions and challenged the hospital – my father would be another fatality of The Liverpool Death Plan.

Apparently, thousands of “do not resuscitate” instructions are added to medical notes each year.  Wouldn’t you want to know if this was being applied to your loved-one? There is UK-wide guidance for health professionals, but the NHS in England leaves official policy to local health trusts, although there are moves at regional level to harmonise approaches. Scotland has a countrywide policy. Clearly we need to demonstrate good practice here which is understood by all parties involved.

While acknowledging that our hospitals and the NHS does a wonderful job, with staff at Addenbrooke’s extremely dedicated, communication from medics during what could be the last difficult moments of a patient’s life needs to fully involve patients and families during what is most likely a very painful time.