Is discussing futile treatments really best for dying patients, asks GP

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No Holds Barred: Is discussing futile treatments really best for dying patients?

Is discussing futile treatments really best for dying patients, asks general practitioner Margaret McCartney in her column in The BMJ this week?

It follows a Court of Appeal ruling that found doctors breached a patient’s right to a private life when they placed a “do not attempt cardiopulmonary  resuscitation” (DNACPR) notice on her records without her knowledge.

The judgment states that CPR is “potentially lifesaving” and that there needs to be convincing reasons not to involve the patient in a DNACPR decision.

But Dr McCartney asks does every decision not to offer ineffective treatment - organ transplant, chemotherapy, dialysis - need to become “patient informed” to absolve doctors from potential future blame? Should “badgering” be the norm?

And how informed must patients be, she adds? “Should we now ensure that every patient who we think nears death, and their relatives, understands in gritty detail that they will not be offered CPR - even though it would be useless? Is this kind?”

She acknowledges that the default should be sharing all information, but explains that “in the real world patients present semiconscious and with recent terminal diagnoses; families disagree; and imparting and checking the understanding of information may require days when there are only hours left.”

She believes that CPR is becoming fetishised. “Doctors withholding it will have to explain themselves. But doctors who break ribs and bruise the lips of terminally ill people, even knowing its futility, will not. Can this really be what patients want?”