It’s more than four months now since my 75th birthday, but I’m still waiting for a ‘cold call’ from the NHS to ask if I have ‘thought about resuscitation’. This is what the Daily Mail warned me last week that anyone over 75 might now receive. As it so happens, I do quite often think about resuscitation, though only in the sense that I would like to be somehow revived when I fall asleep at my desk. But the Mail was talking about something different: NHS guidelines by which doctors are required to ask their elderly patients if they would like to be resuscitated when they suffered a heart attack or a stroke or other such life-threatening events. The paper was spluttering with indignation over this ‘extraordinary new guidance’, quoting ‘medical professionals’ as saying that it was ‘blatantly wrong’ and would frighten the elderly into thinking they were being ‘written off’. It mentioned particularly the shock felt by patients, visiting their medical centre for a routine check-up, at being suddenly confronted with a question about whether or not they would like to be left to die.
All this was emblazoned on the Mail’s front page as something new, but it is now almost a year since I went with my brother John to just such a routine check-up and saw him undergo the same experience. John, who died on New Year’s Eve, was already aged 87 and suffering from a motley collection of ailments that included Parkinson’s, diabetes and chronic obstructive pulmonary disease. His very nice and sympathetic doctor explained to him that the NHS had recently introduced a new service for people whom it delicately described as ‘more at risk of unplanned hospital admissions’ than others. As one such, he was told he would be assigned a named GP to take special care of him and must fill in a form giving details of his ailments, medication, carers and so on, so that ambulancemen would be fully briefed when they turned up in an emergency.
So far, so good. But then he was asked whether he would like, added to the form, a ‘do not attempt resuscitation’ order. He looked bewildered. Although much debilitated, he was in fine mental condition and possessed of a very strong will to live. He would religiously take some 30 pills a day and go for stumbling little walks to limit the depredations of his various ailments. Not long beforehand, he had been to see a Parkinsonian specialist in hospital and asked her if she thought his Parkinson’s might shorten his life. He was much displeased when she told him (in so many words) that while it was difficult to say, it seemed that he had lived rather a long time already.
So he asked his kindly GP why anybody could possibly wish not to be resuscitated if he had had a heart attack? The doctor’s answer was depressingly frank. While resuscitation had a 50–50 chance of success with young people, he said, its record with old people was abysmal. If your heart stopped when you were old, you were almost bound to die in any event. But if somebody jumped on you to get it going again, you might not die peacefully but in agony — possibly a few weeks later, but with broken ribs and probable brain damage. Undaunted by this warning, John elected to be resuscitated. And indeed, when the moment finally came and he was struck down by what was described on the death certificate as ‘ischaemic heart disease’, the paramedics did everything possible to revive him, and they seemed genuinely sad when they announced, after a long period of trying, that they hadn’t managed to save him.
There are inevitably those who suspect that non-resuscitation is just a callous way of saving the NHS money, or that it’s a form of disguised euthanasia. I don’t think so. John’s doctor, a good man, clearly believed that it was a compassionate solution to a nightmare problem. There will clearly be cases when it would be a mistake, and potentially a harmful one, to attempt resuscitation; but it’s a bit much to expect patients themselves to rule out in advance any possible recovery from a medical emergency that they cannot foresee. Rightly, doctors are now obliged by law to consult their patients before placing a ‘do not attempt resuscitation’ order on their medical records. But why does such an order need making at all?