§ Baroness Miller of Hendon
asked Her Majesty's Government:
What are the "national guidelines" adopted in National Health Service hospitals for soliciting "do not resuscitate" instructions from elderly but apparently mentally competent patients; and [HL707]
What age and degrees of infirmity and clinical appropriateness are the parameters under the "national guidelines" for seeking "do not resuscitate" instructions from patients; and [HL708]
In the case of elderly patients not considered fully mentally competent, what degree of consultation with patients' close families the "national guidelines" require before "do not resuscitate" instructions are implemented; and what requirements there are for the intervention of an independent social worker to safeguard patients having no close family support; and [HL709]168WA
Who issued the "national guidelines" as used in the National Health Service hospitals on the solicitation of "do not resuscitate" instructions from elderly patients or their close families; and when; and [HL710]
When and where the "national guidelines" on the solicitation of "do not resuscitate" instructions were published; and [HL711]
What consultation took place before the "national guidelines" on the solicitation of "do not resuscitate" instructions were published and with whom; and when and where the guidelines were publicly debated, whether before or after publication. [HL712]
§ Lord Hunt of Kings Heath
Applicable guidelines onDecisions Relating to Cardiopulmonary Resuscitation were first published in 1993 in a joint statement issued by the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing. A revised version was published in June 1999. The joint statement gives only general guidelines on the basic principles within which decisions regarding local policies on cardiopulmonary resuscitation may be formulated. It makes clear that all acute hospital trusts should establish local resuscitation policies. The wider ethical context on end of life decisions (of which cardiopulmonary resuscitation is an example) is contained in the BMA guidelines on Withholding and Withdrawing Life prolonging Medical Treatment.
One of the basic principles of healthcare is that a competent patient has the right under common law to give or withhold consent to examination or treatment. The guidelines suggest that where competent patients are at risk of cardiac or respiratory failure, or have a terminal illness, there should be sensitive exploration of their wishes regarding resuscitation.
In the case of patients who are not capable of consenting to treatment, and in the absence of a valid advance refusal of treatment, it is a doctor's duty to act in the best interests of the patient concerned. The overall responsibility for "do not resuscitate" decisions rests with the doctor in charge of the patient's care. Before making a "do not resuscitate" decision, an assessment is made of the patient's best interests and the guidelines specify that this assessment should include consultation with other members of the health care team and, where appropriate, relatives or those close to the patient. However, the latter cannot determine a patient's best interest nor give consent to or refuse treatment on a patient's behalf. Although the guidelines suggest that resuscitation decisions should be subject to audit, the involvement of an independent party in individual decisions is not specifically required.
The guidelines recognise that the decision arrived at in the care of one patient may be inappropriate in a superficially similar case. "Do not resuscitate" decisions should therefore be reached on a case by case basis. Thus a blanket "do not resuscitate" policy based on a specific patient group (for example, 169WA elderly patients) would neither be appropriate nor acceptable.
Consultation on the guidelines is a matter for the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing, which were responsible for its development.