United Kingdom Doctors make end of life decisions??

K+MgSO4, BSN · Feb 26, 2011

It is the doctor that signs the not for resuscitation form that sits at the front of a patients chart.

however anyone can bring up the topic - the family can request it, the medical team have to discuss it and sign it before a patient is referred to palliative care, the nurses can bring it up with the patient and the family.

I have spoke to families and suggested to them that palliation may be the way to go rather than active treatment. I have also asked lucid patients who are severely unwell what their wishes are.

But it is up to the consultant or his registrar (2nd in command) to sign the document in an acute hospital. If someone died at home the family will usually call the GP and the undertaker. In a nursing home their GP is SUPPOSED to sign the document.

Not sure where it is documented in law. My experience is Irish but 95% of our laws are the same because until 1916 we were ruled by Great Britain so their tort is ours etc.

Silverdragon102, BSN · Feb 26, 2011

A few years ago I remember a case where I worked and the Consultant went over the family's wishes due to the poor quality of life that the patient had and that to resus the patient we would have probably had to break their arms and legs just to get to the chest due to the contraction of limbs. this was after a long discussion with family by both nursing staff and doctors. Sometimes I think the families prefer it when the medical/nursing team take over

ayla2004, ASN, RN · Feb 26, 2011

Can i ask the OP what do you mean by end of life.

DNAR are medical decison however for a competent adult pt it is their joint decison. Familly arent always consulted although best practice is to involve them. if they haven't and become aware of this they do at times disagree and cant understand why it is futile and not in the pt best intrest the DNAR can be withdrawn.

However end of life is more that this. When a pt detriotes and fails to respond and there is nothing left to try then we like the familles to have seen this and sometimes have a pre emptive talk about comfort care.

Generally if they have had ipen visiting for a poorly pt they can see what we have done and the lack of response and they agree with comfort care.

We have now changed out policy to make sure the familly know(not good when you cant get hold of them, however we can be covered by medics to stop vital signs etc.

allnurses Guide · Feb 28, 2011

I have a question that I was wondering if someone who works in the United Kingdom could expose more light on this. I heard somewhere that in the UK doctors are the ones that make the decision when to stop treatment on a patient. Is this true? At my hospital in the US its the families who have most of the rights unless there is a problem that is ethically wrong, then there is an ethics committee called. I would love to hear personal stories and to know if someone could tell me the place to find the exact law.

There are a few issues within your post that I think can be addressed.

Stopping or withdrawing life saving treatment

In the UK ultimately it is the doctors' decision, there is guidance from the General Medical Council for doctors who are in the position of having to make such a decision

1. Doctors have a responsibility to make the care of their patients their first concern. This is essential when considering any of the growing range of life-prolonging treatments which make it possible to extend the lives of patients who, through organ failure or other life-threatening conditions, might otherwise die.

http://www.gmc-uk.org/guidance/ethical_guidance/witholding_lifeprolonging_guidance.asp

The link that I have provided explains in details the doctors responsibilities and ethical considerations.

In practice, these decisions are made in collaboration with the family and patient where appropriate, but the doctor will act in the best interests of the patient and if it is considered that prolonging life will cause suffering then the doctor will make that decision.

I have witnessed some excellent doctors who have communicated and provided information to allow families to come to terms with the decision, at the end of the day no body wants their loved ones to suffer unnecessarily. I have also witnessed some appalling discussions which have left the family distressed and feeling excluded from the decision. Where I work we access the palliative care teams when making these decisions and they support the families and discuss options.

I have only once been in a situation where a family has disagreed with the decision to discontinue care, even after the facts and information was presented, the doctors respected that decision, however revisited it at various points during the care and eventually the family agreed that it was in the patients best interests and continuing care was causing unnecessary suffering.

There is guidance that allows nurses in the UK to make resuscitation decisions as well, this can be found here

http://www.resus.org.uk/pages/dnar.pdf