IT IS important for medical practitioners to identify patients for whom “do not attempt resuscitation” (DNAR) orders would be appropriate to prevent a “lack of dignity in otherwise inevitable deaths”, a public meeting heard yesterday.
Dr Deirdre Madden, a senior lecturer in law at University College Cork and chairwoman of the National Consent Advisory Group, said that cardiopulmonary resuscitation (CPR) was not originally intended for terminally ill patients but was now commonly used to treat any patient who had a cardiac arrest.
“In many cases where it is used it will not work, it will not be effective or successful, it may indeed cause harm to patients,” she said.
Dr Madden, who urged those present to take part in an ongoing national consultation process on DNAR orders which runs until June 28th, said DNARs as envisaged under the policy document referred just to resuscitation and did not affect patients receiving other forms of treatment.
Dr Patrick Plunkett, clinical professor of emergency medicine at Trinity College Dublin, clinical director emergency directorate at St James’s Hospital, Dublin, and commissioner at St John Ambulance Brigade of Ireland, said that “many people who were having CPR inappropriately should be allowed to die in their own time and in comfort and in dignity”.
Dr Plunkett said while there was societal discomfort around DNARs that, given the inevitability of death, people needed to consider well in advance “what would I want for myself?”
Meanwhile, Dr Siobhán O’Sullivan, the chief bioethics officer at the Department of Health and chairwoman of the DNAR sub-group of the National Consent Advisory Group, said that the general principles of the envisaged policy were “open, honest, sensitive and ongoing communication” in what was a co-decision-making process between patients and their doctors.
She added that doctors for their part needed “requisite training, knowledge and communications skills”.
Dr O’Sullivan said there appeared to be a lack of consistency in Ireland around how the decision to resuscitate was taken, a reluctance to discuss DNARs and a lack of clarity around roles and responsibilities for doctors, patients and family members.
She said that a national policy would help to ensure that DNAR policies were implemented in a consistent manner across the health system.