By Dr Vernon Coleman
Patients in hospital are today routinely asked if they will accept to having a ‘Do Not Resuscitate’ note printed on their medical records or stuck on the chart at the end of their bed.
The idea of not resuscitating seriously ill patients goes back to Hippocrates (who used to be considered the father of medicine) who originated the phrase: ‘Thou shalt no strive officiously to keep alive’.
And when that principle was introduced into modern medicine it was intended as a form of compassion. The thought behind it was that very elderly patients who were terminally ill, and therefore by definition not going to recover from their illness, should not be subjected to the sometimes painful process of resuscitation. The need for this grew as resuscitation techniques improved and became more complex.
Within the last few years this has changed dramatically. Today, patients in their 50s and 60s are frequently asked if they will agree to having a ‘Do Not Resuscitate’ notice put on their notes. With older patients the DNR notice is pretty well a default. And patients in their 20s and 30s who have a chronic physical or mental condition are also likely to have a DNR notice slapped on their records – often without a member of the hospital staff telling them what has happened.
A few years ago DNR notices were only offered to patients after a full consultation with the patient and their relatives. There would always be a discussion between the doctors responsible for the patient’s care. These days individual doctors and even nurses are allowed to make the decision that a patient should not be resuscitated. And in some hospitals, otherwise healthy patients undergoing routine surgery or treatment are often asked if they will agree not to be resuscitated.
‘If there is a problem after your operation, do you really want us to resuscitate?’ the patient will be asked. ‘The process can be painful and may sometimes result in the breaking of ribs.’
The patient, terrified out of their wits and already nervous, will then often agree that they really don’t want to be resuscitated.
But this is like an emergency telephone operator saying ‘Do you really want us to send an ambulance? If the ambulance crashes after it has picked you up then you could be seriously injured or even killed.’
The official claim is that DNR notices are being offered very widely (and routinely with older patients) to ensure that patients are not subjected to a potentially painful procedure if, for example, their heart should stop during or after a surgical or medical procedure.
That’s not the truth, of course.
The truth is that DNR notices are being distributed like confetti at a celebrity wedding in part because the authorities are desperately aware that hospitals cannot cope with the number of patients they are expected to look after (there are political and administrative reasons for this – which I have discussed in my short book The NHS: What’s wrong and how to put it right) but mainly because governments believe that the world’s elderly population has grown too large and must be culled. The real problem (which is rarely if ever mentioned) is that a huge elderly population is expensive – both in terms of pensions which have to be paid and in terms of the care the elderly need – and that the size of the elderly population must be reduced. DNR notices have become popular because those in charge believe they are a simple way to get rid of burdensome individuals who do not contribute to society.
The use of DNR notices in hospitals brings back unpleasant memories of the work of Karl Binding and Alfred Hoche in Germany in the 1920s who together wrote about the legality of killing the mentally ill and on euthanasia in general. Their work influenced the Nazis policies on these issues which are not dissimilar to the modern eugenic policies of the National Health Service in the UK. Indeed, the policies are identical.
In the UK, and the modern world, the purpose of distributing DNR notices with such enthusiasm is, of course, to reduce the number of sick people and to help reduce the global population.