Please read this article in the Colchester Daily Gazette. It details a row that has erupted after Colchester PCT advised care homes not to automatically dial emergency services when a resident is dying.
I presume care homes in Colchester have become involved in the national drive to 'sign-up' en masse residents to Advance Decision to Refuse Treatment (ADRT).
Residents and relatives of those residents not deemed to have mental capacity are being coerced by Link GPs and indeed care homes (who wish to proudly boast they have achieved Gold Standard) to Advance Care Planning.
It has happened in my area with devastating results, many residents being highly offended and highly confused by this unrequested approach and relatives feeling pressured into making decisions they do not want to make.
What really concerns me about this article is that the family of Ellen Williams seem unclear as to exactly what they have signed, believing that she has been "put on the Liverpool Care Pathway "do not resucistate" plan." What is this? Clearly from the article she (Ellen) is not "on" the LCP - but clearly, her future (lack of treatment) is well mapped out.
I can only assume that the link GP discusssed placing Ellen on the LCP when she is in the process of dying and during this discussion the family requested or agreed to Do Not Attempt Resuscitation (DNAR).
However, it is important to state that DNAR decisions only apply to CPR (cardiac massage and artificial respiration) and not to any other aspect of treatment - such as comfort measures: antibiotics, analgesia, hydration and feeding (any route), oxygen, hospital admission and suction. DNAR does not mean Do Not Treat (DNT).
Four residents in my home have ADRTs in place - three requested by relatives when their loved one was 'in the process of dying' and the fourth when the GP requested to see the relatives for the same reason. All have a DNAR in place, relatives have requested no hospitisation for two of these residents and all relatives have requested active treatment should their loved ones become ill. All of these residents are still alive!
So the question needs to be asked that if the GPs were wrong in these instances why nurses are deemed to have the skill of recognising 'dying' when it suits a PCT. If I am concerned about the health of a resident - something which can't wait until a GP visit in the morning - I phone Out Of Hours (OOH) Services and often, when giving details I am informed that I should contact emergency services - because they can't be arsed to come out! If I felt emergency services were required I would have done this.
Of the four residents mentioned previously, if thought required, I would contact emergency services for two of them. The remainder I would contact OOH. Nursing home nurses are between a rock and a hard place - with regards to requesting GP input - they are damned if they do and damned if they don't! I will not take risks with a residents life - I am not a doctor. Woe betide me if I sat by and did nothing should a resident become critically ill - I am a hundred percent certain no PCT or GP would back me up! I would be hung, drawn and quartered!
I am concerned re Dr Shane Gordons statement, feeling he has totally missed the point that there is a lack of clarity, a lack of understanding of Advance Care Planning and an unawareness of the ramifications of signing same.
I wonder if he has read "This paper desribes the protocol of a multidisciplinary study that will provide timely and essential insights into an area of end of life care, ACP, which has become policy driven within the UK despite a weak evidence base."
Advance/Anticipatory Planning (formerly Living Wills) is fine and dandy if it is a choice you make yourself. If I had a terminal illness - I would request and sign one myself. Okay dementia is terminal, but it is not a tomorrow thing. Until it reaches end-stage you have a right to treatment.
We all get old some day - even doctors and those who manage PCTs.