end of life care and dnar
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End of life care and DNAR. Rachel Podolak, Head of Welsh Affairs. Who we are and what we do. Our role is to protect, promote and maintain the health and safety of the public. We maintain the register of doctors and set the standard for entry to the register - PowerPoint PPT PresentationTRANSCRIPT
End of life care and DNAR
Rachel Podolak, Head of Welsh Affairs
Who we are and what we do Our role is to protect,
promote and maintain the
health and safety of the
public.
• We maintain the register of doctors and set the standard for entry to the register
• We set and promote the principles and values of good medical practice from medical school to retirement.
• We take action to protect patients.
MMaanncchheesstteerr
.
Hitting the headlines
End of life care - key principles
The presumption in favour of prolonging life -
not an absolute obligation
Life-prolonging treatment can be withdrawn or
not started – if refused; or if it is not of overall
benefit to a patient who lacks capacity to
decide
Plan ahead as much as possible with the
patient, healthcare team, carers and other
services
Provide appropriate palliative care e.g. pain
relief
Respect patients’ views and wishes. Treat
patients and their carers with sensitivity,
dignity, and fairness
Issues covered in the guidance
Equalities and human rights 7-13 Advance care planning (incl. palliative care) 50-
62
Advance requests for/refusals of treatment 63-74
Clinically assisted (artificial) nutrition and hydration (C/ANH) 112-127
Cardiopulmonary resuscitation (CPR) 128-146
Advance requests
Advance requests for treatment:
Not legally binding – evidence of a patient’s wishes
Will carry weight in future decisions about the balance of
benefits, burdens and risks of treatment.
If the benefits, burdens & risks of a treatment are finely
balanced; the patient’s previous request to have it will
usually be the deciding factor.
Advance refusals
Advance refusals of treatment:
Must be ‘valid and applicable’ to be legally
binding
If not – then treat as evidence of a patient’s
wishes
Do Not Attempt CPR decisions
The decision making principles that apply
to other treatments also apply to CPR when
doctors are deciding if it should be
attempted at a future date. We ask doctors
to be clear about:
when to talk about a DNACPR order with
patients and/or their family and carers
what to explain – public myths; patients’
fears
whether they are ‘consulting’ or
‘informing’
the different roles of the doctor/team,
patient and family, in making the
decision
Decision making
And finally….
Questions you may wish to consider:
Was it good clinical practice (up to date, evidence based)?
Were GMC decision-making principles applied?
Were the issues considered carefully; and was advice sought?
Did the Dr make a ‘reasonable’ decision in the circumstances?