An Oxford conference last week was told that only one in 50 medics were of the opinion that resuscitation should be employed in every case except where a patient had specified their choice of ‘DNAR’ (Do not attempt to resuscitate).
The conference was told that deploying a crash team in every case of organ failure could cause distress to all involved.
The finding was one debated by 200 health care workers, priests, patients, relatives, economists, scientists and teachers gathered at St Catherine’s College last week. The “Talking about Dying” conference was sponsored by the Collaborating Centre for Values-based Practice in Health and Social Care and the Oxford Healthcare Values Partnership.
Professor Ashok Handa welcomed Evan Davis, presenter of Newsnight, to chair the discussion. Davis noted how the principal agent theory in which a salesman for an insurance policy is incentivized by money and so may well sell the wrong policy explains much that goes wrong in decisions about death.
He commented that the patient will only make the decision once, the relatives might defer to the doctors and the doctors want to ensure that they have done everything possible and in so doing fail to allow nature to take its course.
A panel started the conversation, opened by Dr Elaine Sugden co-author with Philip Giddings, Martin Down and Gareth Tuckwell of “Talking about Dying”, which was the catalyst for the event.
Mrs Pamela Richards, who is undergoing experimental treatment for a life-threatening cancer, spoke of the support of people praying for her, and how she thought the trial might do her some good and help other people. She was warmly applauded.
Joel Ward, a recently qualified doctor, said that, observing events in hospital, he believed that things went better when people had thought ahead about whether they wanted resuscitation and when they were treated by the same doctors throughout.
The conference heard that honest and productive conversations with patients and, where appropriate, their family and friends,promote a better death.The assumption among medical professionals that everyone wanted to prolong treatment was unhelpful even among younger people.
Dr Graham Collins, a haematologist on the panel, spoke of a patient in her 20s who, after several courses of treatment decided not to continue. He said that different metaphors were needed to describe people’s experience: a “battle against cancer” may be initially inspiring but the inevitable outcome means that everyone has been defeated.
There was universal approval for making sure that hospice places should be available to all when needed.“Making palliative care services available for everyone would be one thing I would change,” one delegate said.Others asked whether doctors should treat symptoms to prolong life or help prepare for a good death with loved ones around and out of pain.
Dying was not a failure, a bad death was, the conference heard.
A fascinating development was the emergence of the issue of “what comes next?” and “hope”. Hope did not necessarily depend on “Where there is life there is hope” which led to further unneeded treatment.
Philip Giddings asked: “What values underlie a positive outcome?”. Dr Collins noted that hope in life after death could transform the situation of a conversation.
Church of England Newspaper 23 November