Over 75? Sign here if you're ready for death: Please sign our Do Not resuscitate order !!

[citizenB]

Over 75? Sign here if you're ready for death: Please sign our Do Not resuscitate order !! GPs to ask ALL older patients if they'll agree to a 'do not resuscitate' order

 

New NHS guidelines urge GPs to draw up end-of-life plans for over 75s

Also applies to younger patients with serious conditions, such as cancer

Told to ask if patients wants doctors to resuscitate them if health worsens

Medical professionals say it is 'blatantly wrong' and will frighten elderly

 

 

Read more: http://www.dailymail.co.uk/news/article-3056621/Over-75-Sign-ready-death-GPs-ask-older-patients-ll-agree-not-resuscitate-order.html#ixzz3YVnoISMH

 

 

 

Doctors are being told to ask all patients over 75 if they will agree to a 'do not resuscitate' order.

 

New NHS guidelines urge GPs to draw up end-of-life plans for over-75s, as well as younger patients suffering from cancer, dementia, heart disease or serious lung conditions.

 

They are also being told to ask whether the patient wants doctors to try to resuscitate them if their health suddenly deteriorates.

 

 

 

 

So, it is ok for this to happen when the NHS want to save money, but someone who is already suffering from a dreadful disease who wants to end their life.. Cannot do so ??

[citizenB]

The age group they are targeting will include those who have fought in the 2nd world war, Korea, etc.. they will have contributed to the "system" by way of tax and insurance, etc.

 

21st Century Britain.. what a way to treat our elderly !!

[citizenB]

 

Euthanasia. Rationing. Assisted Suicide. These are the kinds of concerns the pro-life community brought up when Congress pushed through Obamacare and government-run health care. These concerns are already becoming real in the Untied States, but a new story out of the United Kingdom should give Americans a hint as to what’s next.

 

Nurses who are a part of in-home health care programs for the sick, elderly and disabled are coming forward to say they’ve been told to ask such patients not if they need medical help but if they need assistance in killing themselves.

 

The nurses say patients are asked via a form if they want to sign a DNR order making it so no efforts would be made to save their lives in emergency circumstances.

 

The elderly patients are given these forms and asked these questions as a part of Britain’s NHS program, the government-run health care scheme. Experts fear patients will feel pressured into giving consent to avoid trouble.

 

 

The forms were sent to patients in June and then returned to their doctors and they target patients over 75 and patients with long-term medical conditions — both of whom may be vulnerable to pressure to end their lives to ration their health care.

 

For the full article. http://www.lifenews.com/2014/08/20/nurses-on-home-visits-to-patients-told-to-ask-can-we-kill-you/

 

Seems as though it has been going on since at least June 2014.

[citizenB]

Roy Lilley, a health policy analyst whose mother was visited by a nurse with the form, described the policy as callous.

 

‘Elderly, frail but otherwise healthy people are being asked, by complete strangers, to sign a form agreeing they shouldn’t be resuscitated,’ he said. ‘It is outrageous. People will be frightened to death thinking the district nurses know something they don’t and will feel obliged to sign the form so as not to be thought a nuisance.

 

 

From the same article linked above.

[p3t3r]

I can understand both sides of this argument (DNR)

 

If I was elderly and dying, I would not want a blast of electricity (higher than mains electricity) to shock me whilst I am going through the process of dying.

 

Standard of care exists during the time the person is alive as well as during the time they are dying. On occasion, it is better to let the patient die a natural death instead of trying to keep them alive. This is why patients are being asked to make their own choices in this matter.

[Guest]

...., I would not want a blast of electricity (higher than mains electricity) to shock me ...

 

...

 

have had a mains shock, nasty, havent been the same since

 

seriously though, another thing that concerns, is when they (even a hosp doc for eg) gets a patient to just sign something when they are not compos. it happens.

cld imagine then this dnr being poss abused.

derriford hosp?

[citizenB]

p3t3r

 

I think the point of the article is that, some elderly people will believe that they are more less obliged to sign these forms, especially where a trusted medical professional is asking them to do this.

 

Wasn't the main issue in the Euthanasia arguments that vulnerable elderly people would need to be protected from greedy relatives ! Now they just need to be protected from politicians and a crumbling NHS !

[honeybee13]

This seems outrageous to me unless we've missed something. 75 isn't particularly old these days and I don't understand why anyone in reasonable health would want to sign one of these.

 

My parents both had DNRs but not until they were around age 90 and with health problems.

 

It sounds as if people are being written off before their time.

 

HB

[citizenB]

Not only would it save money for the NHS, but the state pensions of these people would also cease.

 

As the retirement age is gradually being edged toward 70.. asking people to sign their own death warrant for 75 is quite cynical !

[Conniff]

New NHS guidelines urge GPs to draw up end-of-life plans for over 75s

 

 

Does that mean they are handing out free wills !

[nolegion]

DNR. That 'casual' initialism is of huge and disgracefully unacknowledged significance in our medical system. In my opinion, in some circumstances it might be thoroughly 'merciful'; in others it could be downright sinister.

 

The fact that so many patients and their relatives do not even know about its existence\ application is being revealed by the new 'consultation' process, as this timely and accurate thread has spotted.

 

I have been asked twice in the last few years to give my prospective 'agreement' (which agreement would be of dubious legality in the light of e.g Mental Capacity Act 2005 s20 http://www.legislation.gov.uk/ukpga/2005/9/section/20 in any event) to 'DNR' possibilities in respect of severely ill relatives.

 

Once in a fairly formal setting of a medical review meeting with more than one concerned relative present and more than one medic pitching the options. The other in an unsolicited telephone call from a GP which caught me hurrying on the way out to a medical appointment of my own.

 

The entire approach of the medical profession (and I mean the medical profession, not juts the NHS) to 'end of life care' ( or potential end-of-life care) is 'random'. Not 'tailored' but 'arbitrary'. And if 'determined', probably more prejudiced than considered. Depends which doctor, which hospital, which contacts, which place, which management. I think our love ones deserve better than this, and so do you and I when we get there.

[Sali]

Does the NHS think that people are incapable of making their own decisions and articulating them when necessary, that they need to be cold-called by an anonymous pratice nurse? Perhaps the GP practices get a bonus for every person they sign up for DNR, just like they do for dementia diagnosis.

 

What if an individual rushed into making a decision then changes their mind? Many people know how difficult it is to get their medical records changed.

 

Truthfully, I think it makes no difference what you decide, the medics have their own rules on who lives and dies and much linked to cost. No gently falling off this mortal coil, but roughly shoved as bed-blockers.

[goodatresearch]

Its strange isn't it. Were frequently told were living longer so should work longer, but at the same time we should consider signing a "do not resuscitate form" at 75. As you said, very cynical indeed. So they can push the retirement age continually upwards and eventually it will hit 70, but you won't be deemed worthy of resuscitation.

 

 

Not only would it save money for the NHS, but the state pensions of these people would also cease.

 

As the retirement age is gradually being edged toward 70.. asking people to sign their own death warrant for 75 is quite cynical !

[p3t3r]

Sali. How I wish I can say your post is wrong. I really wish I could.

 

Yes, a GP would receive a 'bonus' for every person they sign up for DNR.

[Sali]

What? Is this true?

[Guest]

.........

...., the medics have their own rules on who lives and dies and much linked to cost. .....

derriford hospital for eg?

[p3t3r]

Sali, yes, unfortunately it is true that a GP will receive a bonus for placing a patient on DNR. I am not sure of the amount of bonus, though it is probably around the same amount as the bonus received for diagnosing a patient with dementia.

[p3t3r]

Sali, I've done a quick google... The amount of bonus is £55

 

Full article can be read here: http://www.dailymail.co.uk/news/article-2468112/Revealed-How-GPs-paid-50-bonus-elderly-death-lists.html

[Guest]

[Sali]

derriford hospital for eg?

 

Tell us the story.

 

***

 

P3t3r

I read the article, although some comments (obviously from those working in the health sector) suggest that it is untrue. What we need confirmed is whether the doctors are receiving a salary and then additional payments for dementia diagnosis, DNR preferences, flu jabs, or even NOT referring patients for hospital tests. If this is indeed the case then it is hard not to be cynical and believe that the GPs will chase the money to the detriment of other patients with other conditions which do not attract a bonus.

 

I do not see the worth of dementia diagnosis (which I question the accuracy of) unless it triggers a pathway of care, involving treatment options (some drugs are available to slow the progression), therapy, home help etc. I don't even believe that the government of the day will use the data to plan for future care needs. I feel dementia patients and their carers (if they remain at home) get a raw deal at the moment.

 

Perhaps there is a time and a place to discuss a death plan, but it should not be prompted by a cold-call. Personally, I might express my thoughts to those cloest to me, but I wouldn't want it on my medical records...I might change my mind.

[citizenB]

Sali, I've done a quick google... The amount of bonus is £55

 

Full article can be read here: http://www.dailymail.co.uk/news/article-2468112/Revealed-How-GPs-paid-50-bonus-elderly-death-lists.html

 

 

I can see the GPs in Stockton on Tees are going to start moaning then..

 

http://www.bbc.co.uk/news/uk-32542880

 

It would appear if you are born in Belgravia, London you can expect to live until you are 91 years old.

 

However, if you are born in Stockton on Tees, your life expectancy is 67 years.

 

So.. not only will the GP not receive a bonus for signing you up for a DNR at 75, but the poor guy who will pay into a pension all his working life, wont even live to receive his state pension ?

 

The good news is, that they can die knowing that they have contributed to the State Pension pot for someone born in Belgravia !!

[think about it]

I've just caught sight of this getting back of holiday and I thought it best to perhaps try to clarify a few things.

 

So, being signed up for a DNACPR? No, having an end of life plan. Yes.

 

Can we in our locality claim for doing them? No. Do we still do them? Yes.

 

That plan might be that, like me, you want to be made as comfortable as possible and pass away peacefully, or it might be that you want every possible intervention before being declared. That's just it, it's a plan. Those questions need to be asked earlier rather than later, quite often when it really matters you're not in a position to express your opinions on the matter and the decisions are left to whichever distraught member of your family or team of carers finds themselves in your presence in your final moments. People panic when bad things happen, so having a clearly defined plan of YOUR preferences is exactly what's needed.

 

I had the displeasure of sitting around the table having that very conversation with regards to my grandfather not more than 10 months ago. Instead of knowing what HE wanted, we were left negotiating with each other over what we thought he might have wanted. That's not right.

 

There is a massive difference between the discussion that takes place at the start of an end of life plan and the discussion that happens when a DNACPR form is put on the table for a family to agree on and sign.

 

I'd urge anyone to start thinking and more importantly telling those around you what YOUR wishes are so that they're not in that position of making a decision for you when you're unable to.

 

Do I agree with opening that conversation over the phone, never. I'd go crazy if I knew any member of my practice team were doing that. But, I am absolutely steadfast in the belief that the conversation does need to happen. I posted a while ago about ceilings of care and since then I've read more about how the Emergency Medicine community has looked at whether or not to perform CPR is ethical in cases with a near zero chance of survival. It is, after all, a medical procedure and subject to the same decisions that drive a person to agree to perhaps surgery where the chance of success is less than 1%.

 

I'll finish by offering my personal view on end of life planning. I have, despite being in my mid-thirties, an end of life plan. I have already expressed my wishes not to be resuscitated in any other scenario than a witnessed arrest. Why, because I've seen CPR for real and had the terrible experience of unsuccessfully performing it. There's nothing good about it and frankly the media depictions of it are, for the most part about as true to life as an episode of Ben and Holly's Magical Kingdom is about what goes on at the bottom of the garden. The chance of going on and living a normal life even if the resus team restore a spontaneous rhythym is minimal, even in an otherwise healthy individual.

 

That aside, end of life planning or advanced care planning is a vital part of medicine. Death is perhaps the only true certainty for us all. Yet we seem to dread talking openly about the actual act of dying. Watch enough TV and you'll get bombarded by Parky or June Whitfield selling you over 50's life insurance, open a local paper and you'll see funeral directors offering pre-payment plans so we get the send off of our choosing yet that bit in the middle, the actual dying bit, gets brushed under the carpet. The adverts are full of soft-touch phrases like 'when you're not here anymore' or 'when the worst happens', it's like a mid eighties feminine hygeine advert.

 

It's a hugely emotive subject, there's no denying it but in the same way that 10 years ago Mental Health was taboo, and twenty years before that AIDS was too it's time we spoke openly about the only thing in life that's absolutely certain. Death.

[think about it]

What we need confirmed is whether the doctors are receiving a salary (depends on the Dr, some are partners in the practice and others are salaried like any other employee) and then additional payments for dementia diagnosis(not here, perhaps elsewhere), DNR preferences (not here, perhaps elsewhere), flu jabs (yes, last year here it was £7.97 per injection. This covered the cost of the injection itself which had to be bought and paid for by each practice directly from the distributors and the time of those in administering and recording the vaccinations - these are most likely done in extra clinics so as not to disturb the normal running of the practice and so results in overtime for the nurses involved), or even NOT referring patients for hospital tests(not here and I've not seen or heard of any incentives attached to this, even still those clinicians I've worked with are steadfastly against any such 'massaging' of figures and will refer when appropriate). If this is indeed the case then it is hard not to be cynical and believe that the GPs will chase the money to the detriment of other patients with other conditions which do not attract a bonus.

 

Perhaps there is a time and a place to discuss a death plan, but it should not be prompted by a cold-call. Personally, I might express my thoughts to those cloest to me, but I wouldn't want it on my medical records...I might change my mind. As I said above, this is a care plan for those approaching an age. Like anything there's an arbitrary line drawn in the sand about when to start doing it and if they've chosen 75 then so be it, the importance is that it's a plan about how you'd like to be treated in your final days and not a "let's set a date to bump you off", those final days might not happen for another 30 years and of course people are entitled to change their mind, just as they do with delivery plans when pregnant. The important thing is to express your thoughts to those around you and if it's also held on your records, to update that too.

 

 

See above...

[think about it]

I understand that some of my answers to Sali's post mace have prompted more questions about locality differences and additional services with associated payments. If you scratch the surface of General Practice you'll see several different funding streams aimed at providing care to patients in a number of different ways. The most common beyond the Main GMS contract is the 'Enhanced Services'. The following link explains them as well as I can:

http://www.thursohalkirkmp.co.uk/enhanced_services.php

 

Therefore different practices might offer different services based on the skill set of their GP's. We're happy to cauterise, cut out or even freeze a lesion or wart but if you want a contraceptive implant fitting then we'll send you to a neighbouring surgery where the team is properly trained to do so. Just as our neighbours send their patients to us for more specialist medicals for things like offshore work. These LES's as we call them are just that, locally commissioned to meet a prevailing need. I'll reserve my views on the Daily Mail for another day but if you want the real purpose of the advanced care planning and the figures involved they're found here

http://www.pcc-cic.org.uk/article/new-enhanced-services-201314

 

 

http://www.nhsemployers.org/your-workforce/primary-care-contacts/general-medical-services/enhanced-services/enhanced-services-201415

[Sali]

.... not to perform CPR is ethical in cases with a near zero chance of survival..

 

Unless our medics are also seers and soothsayers, this is an impossible call.

 

Are there any independent studies in the UK relating to success rates for CPR?

 

Personally, I think that dying might be the easiest thing I ever do in my life. It's the endgame, those last days/weeks/months (maybe even years for those suffering long-term conditions), that I want to take at my own pace, in my own way, not to feel harried by a bunch of medics who want to free up a bed. Yeah, tell your nearest and dearest your plans, but a formal arrangement, no way! Not just because medical records seem impossible to alter, but I wouldn't trust a medic to read them, even if they could locate them in my hospital.

 

I have read that flu jabs are a lucrative side-line for GP practices, which is why they are resistant to this type of work going to pharmacies (who obviously are doing it for the money too). DNRs too, which could (surely) not be outsourced, must be an easy income source for some surgeries.

 

Incentive payments/bonuses - whatever you want to call them - do not sit comfortably with me, especially in healthcare. You cannot help but worry that they skew focus.

 

I'll return to read (with interest) the links you provide another day.