'Not to Resuscitate' is indeed a difficult decision that has to be made by the patient, when he or she is in good health, or the guardians of the patient. However, according to the law and ethical code of conduct, the medical practitioner, or whoever is in charge of the health care of a patient in a hospital setting, should always inform the patient about the whole procedure (L., 2008). There are certain indications when resuscitation needs to be performed on the patients, meanwhile there are also some contradictions where it should not be performed on the patient. Nonetheless, the final decision lies with the patient or with family. The indications of this decision include a case in which resuscitation would be of any help to save the life of the patient. For example, if the patient is dying and who has been given all sorts of treatment but death has now become imminent and there is no treatment that will save the patient, then resuscitation is normally not performed on the patient. On the other hand, if there is any comorbidity because of resuscitation would be of no help then a request for 'Not to Resuscitate' is given. Such comorbidities include severe pneumonia, significant acute renal failure, hypotension with heart failure and metastatic malignant disease. In such cases, the patient or the family of the patient are normally requested to sign an NTR because it could be stressful for a patient as well as for the family. In this case, Mrs. Lily was not terminally ill and neither did she have comorbidities that have been mentioned above. On top of that, neither was Mrs. Lily nor the family was asked before putting a NTR note on the medical documents of Mrs. Lily. A very strict legal action could be taken on this action of the medical staff.
Most of the doctors and medical staff tend to underestimate the fact that most of the people who know that they are going to die are actually very keen to know about their death. Therefore, doctors and the medical staff should always make sure that the patient is informed about the decision that is being made about the resuscitation procedure. As mentioned earlier, the decision for resuscitation should always lie with the patient. The patient should be informed about the whole procedure clearly and then his consent should be taken about the matter. In cases where consultants think that the life of the patient could be saved by performing CPR (cardiopulmonary resuscitation) but the patient is not being compliant and does not want the procedure to be performed on him or her, then the doctor should counsel the patient. This requires the doctor and the medical staff to show empathy for the patient and to consider them in the place of the patient. Moreover, it is important for the doctor to build a reputation with the patient. These are one of the times when the doctors have to act very professional at a humanitarian level. They have to explain the procedure in a way that does not make the patient scared of what is going to happen to him or her.
It should always be remembered that in a clinical set up, the consultant should be asked to do the job of asking the patient whether or not him or her would want to get resuscitate if the need be. Junior doctors or registrars for that matter should be given the authority to get an NTR letter signed by the patient of the family. However, the junior staff can write the letter and then get it rectified by the senior consultant.
Another thing that is important pertaining to the professional communication is that not just the patient, but also the relatives and care givers of the patient should be taken in confidence. This is especially important if the patient is not the in the state to give his or her own decision. Likewise, the whole protocol of CPR should be explained to the family of the patient and ask them if they want the procedure to be performed on the patient. For example, there is a case where the doctors think that CPR would not save the life of the patient but the family insists on doing CPR on the patient since they believe that it 'might' just save their family members, then it is duty of the doctor to counsel the relatives by explaining why the procedure would not work on them. If the relatives still insist that the procedure should be performed then the doctors should go for it.
In this case, however, the family was not informed about the procedure or its indication and neither was Mrs. Lily. It was the right of the patient and that of the family to know that the doctors think that NTR decision should be taken for her. Professional communication was not exercised in this case and this could have serious implications in the future as Mrs. Lily and her family can sue the doctors and the medical staff.
Role of Advance Directives in Health Care
Advance directives are now being considered legal by the General Medical Council as long as the situation anticipated as part of the advance directive holds significance for the patient who is confused at the moment and there are no chances of the patient to change his or her mind.
The role of advance directives does have a big role to play in the health care system. For example, in this case Mrs. Lily has been feeling unwell and she is being admitted to the hospital frequently than before. The doctors believe that it would be better that an NTR decision is taken for her as they believe that resuscitation would not be of any help to the patient. However, they do not explain to the patient or the family why they are doing so. Moreover, she also not terminally ill and no specific procedure are being performed on her because of whom she might die. Consensus is also not sought in this case.
Basically the meaning of advance directive is that the patient is explained why there might arise a need that he or she would have to be resuscitated. On the other hand, if there is a case in which CPR is contradictory, then the patient needs to be told why he or she would not be resuscitated. The consequence of not resuscitating, which is almost always death, should also be explained to the patient. However, the patient should be reassured that the treatment that needs to be given to the patient would not be discontinued. Therefore, advance directive is a sort of reassurance that is given to the patients before a major decision is made about their treatment.
According to the International Liaison Committee on Resuscitation, the recommended use of standardized physician, who is not working in the hospital in which the patient has brought in, of the patient who has some chronic or terminal illness, is necessary. These recommendations should be written in a way that the healthcare professionals of any other hospital or clinic should be able to understand them easily. Moreover, additional instructions should be given with these recommendations that should be indicative of whether or not the healthcare professionals should start or continue interventions that of the life sustaining nature, and especially of the patients who are in cardiac arrest or about to have a heart failure.
Since laws that govern the use of DNAR forms and that of advance directives are not the same by jurisdiction, the healthcare professionals should have the knowledge of the laws and regulations that are used locally where they are working. On the other hand, the standardized orders for limiting the life sustaining treatments should be taken into consideration so that the ratio of useless resuscitation attempts is reduced and so that it is made sure that the wishes of the adult victim are honored. Apart from this, it is important for these recommendations to be to the point but contain the right amount of details, should be capable of getting transferred across other healthcare settings and should be understood by all healthcare professionals.
Doctors and other healthcare professionals should always make sure that the protocols and the processes that are involved should suit the local norms as well as fit the legal limitations so that the providers are able to respect the wishes of the patient pertaining to the resuscitation attempts (J. et. al, 2010).
Requirements of Consent
Consent is of utmost importance in the medical setup and clinical practice. Doctors are told to take consent from the patients even if they are doing the slightest of procedures on them or even when they have to take their history. It has been made mandatory for the doctors and the nurses to take consent from the patients in their ethical code of conduct. Whosoever does not take consent from the patient…