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Safeguarding patient autonomy…

Guidance produced in 2010 by the General Medical Council (GMC) stressed the importance of upfront treatment discussions with patients (where possible), their loved ones and their healthcare team. Interestingly, the GMC also state that if a DNAR decision has been made and there has been no discussion with the patient because they did not want to discuss it (for example they may be highly distressed at the idea of dying and don’t feel comfortable talking about it), or because the doctor considered that a discussion with the patient was not appropriate, this should be noted in the medical records. This is obviously a grey area of practice, so all actions taken need to be accounted for.

The blame for these incidences uncovered by the CQC cannot rest solely with healthcare professionals. Local systems for recording Advance Decisions (which might include a patient’s DNAR wishes as well as wider treatment preferences) differ across the country and there is currently no central system for recording them. This lack of coordination of a patient’s decisions has particular importance when they are first admitted to hospital and their end-of-life treatment preferences are (or should be) being discussed.

Essentially the CQC report highlights that respect and care for patients is sometimes lacking – whether this is the fault of individual clinicians or the systems they are working within. Our healthcare system continues to struggle with the process of dying, but there are basic fundamentals which we should be getting right and let’s not forget that most healthcare professionals are doing an excellent job in the face of increasingly challenging circumstances.