Paramedics told: 'Let accident victims die if they want to' in new row over patient rights (UK)

UK Daily Mail ^ | 4/17/09 | Daniel Martin

[wagglebee]

Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die.

It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their 'death wishes' in advance.

It is believed to be the first in the country, but other trusts around the country are expected to follow suit to comply with Government guidelines which state that patients' wishes should be taken into account, even at the point of death.

Patients' groups and doctors have welcomed the scheme, but it has met opposition from pro-life groups who say it violates the sanctity of life.

The system would come into play if a cancer patient, for example, was in serious pain and rang 999 for help to alleviate the suffering.

But if the paramedics arrived and the patient was close to death, he or she would not be resuscitated if such a request was registered on the database.

This would also be the case if a patient on the database was being transferred between hospitals, and had a heart attack.

Dominica Roberts from the Pro-Life Alliance said: 'This is very sad and very dangerous. It's another step along the slippery slope, at the bottom of which is euthanasia as we see in Holland.

'Paramedics should be there to save lives. They should not be there to let patients die. The medical profession should not agree with someone's belief that their life is worthless.'

[wagglebee]

Dominica Roberts from the Pro-Life Alliance said: 'This is very sad and very dangerous. It's another step along the slippery slope, at the bottom of which is euthanasia as we see in Holland.'

This is EXACTLY what the culture of death wants.

[wagglebee]

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[JoSixChip]

Is this not equivalent to a DNR?

[driftdiver]

So kinda like when they found that overweight man unconscious and they decided to let him die. Is this what this is all about?

[allmost]

Who signed me up? WTF? (gasp)...

[muawiyah]

How sad a place are the slums of London. The rich people there, even doctors, just step over the bodies of the dead and dying.

[muawiyah]

Not really ~ an accident happens ~ someone is hurt ~ this particular order will cause a serious delay in assisting the injured because the bureaucrats want the first responders to call up and check the list first.

Your local public streets really aren't like hospitals you know.

[GeronL]

“Hello 911 whats your emergency?”

“I am having a heart attack”

“Your number is registered to James A Smith is that you?”

“Yes, please hurry”

“Sir, your registered as being against being put on life support. But you are an organ donor, so I have canceled the emergency ambulance but they will be along soon to collect your organs. Good day sir.”

[GeronL]

Car accident... ambulance arrives.. the cop says hurry... but after checking the man he has a DNR in the database and the ambulance leaves.

nice.

[wagglebee]

Is this not equivalent to a DNR?

It's not even close.

[Diogenesis]

Mitt Romney chortles as he inflicts socialized medicine (HillaryCARE=ROmneyCARE)
upon the Massachusetts citizens, without one of their votes.

---

"National Health Preview - The Massachusetts debacle, coming soon to your neighborhood."
"Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country.
It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls.
As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget.
The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.
The state's overall costs on health programs have increased by 42% (!) since 2006.

What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered.
But reducing costs while increasing access are irreconcilable issues.
Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional.
Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers."

---

A Very Sick Health Plan; Bay State’s ‘Grand Experiment’ Fails [RomneyCare]
"The Daily News Record, Harrisonburg, Va. - 2009-03-31 "
"For folks increasingly leery of President Obama’s plan to radically overhaul America’s health-care system,
or 17 percent of the nation’s economy, all this could hardly have come at a better time —
that is, fiscal troubles aplenty within Repubican Mitt Romney’s brainchild, Massachusetts’ “grand experiment” in “universal” health care."

"Initiated on Mr. Romney’s gubernatorial watch in 2006, this “experiment” has fallen on hard times, and predictably so.
Even though the Bay State commenced its program with a far smaller percentage of uninsured residents than exists nationwide,
“RomneyCare” is threatening to bankrupt the state. Budgeted for Fiscal Year 2010 at $880 million,
or 7.3 percent more than a year ago, this plan, aimed at providing low- or no-cost health coverage to roughly 165,000 residents,
has caused Massachusetts’ overall expenditures on all health-related programs to jump an astounding 42 percent since 2006.

So what does Mr. Romney’s successor, Democratic Gov. Deval Patrick, propose as a remedy for these skyrocketing costs?
Well, whaddya think? The standard litany of prescriptions (no pun intended) — price controls and spending caps, for a start, and then, again predictably, waiting periods and limitations on coverage.
As in Europe and Canada, so too in Massachusetts. And, we feel certain, everyone from Mr. Romney to Mr. Patrick said, “It would never happen here.”
But then, such things are inevitable when best-laid plans, with all their monstrous costs, run smack-dab into fiscal reality.

---

"Hospital patients 'left in agony'"
"Patients were allegedly left screaming in pain and drinking from flower vases on a nightmare hospital ward.
Between 400 and 1,200 more people died than would have been expected at Mid Staffordshire NHS Foundation Trust over three years, a damning Healthcare Commission report said.
The watchdog's investigation found inadequately trained staff who were too few in number, junior doctors left alone in charge at night and patients left without food, drink or medication as their operations were repeatedly cancelled.
Patients were left in pain or forced to sit in soiled bedding for hours at a time and were not given their regular medication, the Commission heard.
Receptionists with no medical training were expected to assess patients coming in to A&E, some of whom needed urgent care.
Sir Bruce Keogh, medical director of the NHS, said there had been a "gross and terrible breach" of patients' trust and a "complete failure of leadership".
The Healthcare Commission's chairman Sir Ian Kennedy said the investigation followed concerns about a higher than normal death rate at the Trust, which senior managers could not explain.
He said: "The resulting report is a shocking story. Our report tells a story of appalling standards of care and chaotic systems for looking after patients. These are words I have not previously used in any report.
"There were inadequacies in almost every stage of caring for patients. There was no doubt that patients will have suffered and some of them will have died as a result."
Julie Bailey, 47, was so concerned about the care being given to her 86-year-old mother Bella at Stafford Hospital that she and her relatives slept in a chair at her bedside for eight weeks.
She said: "We saw patients drinking out of..."

[muawiyah]

Hey, folks could do some real damage here. For instance you could sign up the Hildabeast or her handmaiden from Arizona ~ then, if they ever went to England (highly probable in their jobs) and got hurt or sick, they'd already be scheduled from death in the ambulance.

This kind of stuff could drive Secret Service folks nuts.

[FoxInSocks]

Is this not equivalent to a DNR?

That's my impression.

I wonder how safe the online registry is. Can someone go online and enter a DNR for somebody else without their knowledge? A little conspiratorial, I know, but I'm just sayin' . . .

[JoSixChip]

I see your point.

[wagglebee]

That is precisely what will happen, a guy will roll up with sirens blaring and jump out with a bloody apron and a set of knives.

[wagglebee]

Not really ~ an accident happens ~ someone is hurt ~ this particular order will cause a serious delay in assisting the injured because the bureaucrats want the first responders to call up and check the list first.

It's more than that.

Let's say an elderly person has a DNR due to a heart condition or something. They are walking down the street and get hit by a car and their leg is broken -- what then? Should they be left to suffer in agony with a broken leg? The trauma will surely kill them, but it will have NOTHING to do with the heart condition.

[GeronL]

govcare sounds so wonderful...,. I mean onederful

[OnTheDress]

Driving Into Walls - BBC4 Documentary

Tonight you will learn how to disable your airbag
so as to be able to drive, at high speed, into a
wall for a painless way to ‘wall-out’.

High Points:
Disabling airbag before ‘walling-out’
Choosing a sturdy ‘wall-out’ wall
Register with want-to-die database
Minimum petrol - you don’t want to burn
How to assure state pays for burial
Revise your will before you ‘wall-out’
Writing a meaningful ‘wall-out’ note
Getting even? ‘Wall-out’ with your ex’s auto.

[Charles Martel]

“Sir, your registered as being against being put on life support. But you are an organ donor, so I have canceled the emergency ambulance but they will be along soon to collect your organs. Good day sir.”

Back when the Monty Python troupe filmed "The Meaning of Life", they included "Part V - Live Organ Transplants".

I'd say the U.K. is just a few steps removed from seeing that actually occur. It looks as though they'll first see the scene from Grail where the fellow (equivalent of today's Paramedics) "assists" the old fellow in "getting on the cart".

Guys, those were *comedies*, not blueprints for social planning.

[freekitty]

How crazy can people be?

[little jeremiah]

And how easy would it be to change the database without the person’s knowledge or consent??

[Polybius]

Is this not equivalent to a DNR? .... JoSixChip

Not really ~ an accident happens ~ someone is hurt ~ this particular order will cause a serious delay in assisting the injured because the bureaucrats want the first responders to call up and check the list first. .... muawiyah

Such systems have been around for years, right here in the U.S., and that's not the way it works.

After registering, if you do not want resuscitation, you MUST be wearing a DNR Bracelet to let the first responders know IMMEDIATELY what your wishes are.

You did not get a DNR Bracelet?

You get resuscitated.

You left you DNR Bracelet next to your toothbrush in the bathroom?

You get resuscitated.

Your DNR Bracelet got ripped off during the accident?

Sorry. Sh#t happens. You get resuscitated.

[Polybius]

Let's say an elderly person has a DNR due to a heart condition or something. They are walking down the street and get hit by a car and their leg is broken -- what then? Should they be left to suffer in agony with a broken leg? The trauma will surely kill them, but it will have NOTHING to do with the heart condition.

DNR means "Do Not Resucitate" as in "Her heart has stopped. Start CPR and call a Code Blue".

It does not mean "Do Not Remove from street".

Until her heart stops ..... on it's own, ...... you still have to treat them like any other live person. Them's the rules.

Monty Python: Not Dead Yet

[wagglebee]

You are correct and this is why this new policy is so dangerous.

[goat granny]

DNR are done everyday in hospitals in this country..My father signed one when he went into the hospital. Some hospitals use the term NO CODE and its written on the very front of the chart...patients choice, not government's or anyone else..

[Polybius]

I wonder how safe the online registry is.

As safe as FR is from anybody who wants to register for the first time.

Can someone go online and enter a DNR for somebody else without their knowledge?

Sure. That is why the registry means nothing in the field. Only the DNR Bracelet physically on the patient means something in the field. See Post 23.

You can register your mother-in-law and get her a DNR Bracelet.

The hard part is tricking her into wearing it without your wife killing you. ;-)

[The Great RJ]

I was a paramedic for many years and had on occasion to be called by the families of patients who were terminally ill. Our protocol was that if it was a 911 call we were obligated morally and legally to do everything possible no different than any other patient. However I did have one incident were a distraught family member called 911 when their terminally ill relative had cardiac arrest. We were met at the door by another family member who explained the situation and showed us a signed Do Not Resuscitate order. We canceled the call.

[wagglebee]

A heart attack victim with a legitimate DNR is TOTALLY DIFFERENT from an accident victim.

[Polybius]

You are correct and this is why this new policy is so dangerous.

Maybe you misunderstood my point.

My point is that "DNR" only means no "Resuscitation" after a respiratory or cardiac arrest.

"DNR" does not affect treatment short of respiratory and/or cardiac arrest.

An elderly patient with a broken leg and a DNR Bracelet will be treated just like any other patient ...... until her heart stops.

This policy has been in effect for years throughout the U.S.

If a mentally competent adult patient says, "No more!", the law says that you are required to back off. It's their body and it's their call.

How does an EMT know what "their call" is?

By seeing if the patient is wearing a DNR Bracelet. See Post 23.

Once a mentally competent adult patient has specifically communicated to you that you do NOT have permission to perform CPR or run a Code Blue on her or perform surgery on her or perform whatever else on her, treating that patient against their will is, legally, considered assault.

What if the patient changes her mind about DNR?

Simple.

Take the DNR Bracelet off.

Names on computer registries mean nothing. You only register to be issued an official DNR Bracelet.

Only an official DNR Bracelet physically on the patient means something. You are not wearing it - You get resuscitated.

After completing the Texas OOH DNR Order form, the patient may obtain, at the patient's expense, an optional means of identification. The OOH DNR ID device may only be obtained AFTER fully executing the Texas OOH DNR Order form. A recent amendment to 25 TAC 157.25 gives consumers greater choice in Texas OOH DNR identification devices by allowing more businesses to offer identification devices. The amendment now requires: ............ (1) An intact, unaltered, easily identifiable plastic identification OOH DNR bracelet, with the word "Texas" (or a representation of the geographical shape of Texas and the word "STOP" imposed over the shape) and the words "Do Not Resuscitate", shall be honored by qualified EMS personnel in lieu of an original OOH DNR Order form. ............ OR ........... (2) An intact, unaltered, easily identifiable metal bracelet or necklace inscribed with the words, "Texas Do Not Resuscitate - OOH" shall be honored by qualified EMS personnel in lieu of an OOH DNR Order form.

The field guidelines are strict.

"What if the bracelet is next to the patient and not ON the patient?"

Not valid.. The patient may have taken the bracelet off.

EMS personnel will honor either bracelet around the patient’s wrist as if it were a valid DNR Order Form. Do NOT honor a bracelet that is not attached to the patient. Do not remove the bracelet from the patient, even when the patient is deceased.

[muawiyah]

My coment was about the ambitions of the folks running the NHS in UK, not how our DNR system might work.

[Polybius]

My coment was about the ambitions of the folks running the NHS in UK, not how our DNR system might work.

In that case, you are absolutely correct since the socialized medicine bean-counters know that it costs much less to bury a DOA than to treat a still living patient.

[muawiyah]

And, they come up with new ideas for killing patients repeatedly. Must be a cottage industry in that sort of thing over there, or maybe their government paid nursing corps has attracted all the killer docs and killer nurses in the English speaking world.

[cycjec]

I don’t think so. Some frail sick ppl can defintely not
survive standard resuscitation. (The overuse of the DNR
and using it as a “DNT” Do Not Treat are other issues)
This is the equivalent of pressuring otherwise non
hospitalized persons to forego treatment in the broadest
terms. Would appreciate more from those with expertise.

[cycjec]

Yup there’s a definite possiblity of false registrations
seeing as it happens with DNR orders in hospitals. (The
first print reference that comes to mind is in the Jewish
Observer a few years back I don’t think it’s online)

[cycjec]

Julie Bailey had the right idea. IIRC Robert Mendelson
(Mendelsohn?) M.D. remarked years ago “A hospital is like
a war. Go in with as many allies as you can and get out
as soon as you can.” That’s from memory, might well not
be exact.
I must say I’ve had only excellent experiences in all
serious situation regarding my close kin.

[cycjec]

People named “Smith” or “Santos” etc. should be really
worried.

[wagglebee]

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