An unmerciful end

Editor—Soper's harrowing description of an elderly woman's “unmerciful end” after cardiopulmonary resuscitation by a team of paramedics raises many ethical issues about what constitutes a dignified, natural death.¹

My research group runs training courses in communication skills for healthcare professionals working in oncology. We have been dismayed by the number of specialist registrars and senior house officers working at a large, famous cancer institution who have asked us recently for help about discussing “do not resuscitate” decisions with patients who are dying. The BMA guidelines recommend that consultants should have ultimate responsibility for this onerous and sometimes deeply distressing task, but in reality it falls on their juniors.

As we worked with our team of simulated patients (actors) on different scenarios that the doctors had had to confront, the actors expressed incredulity that this should even be a topic for discussion with patients. Who in their right mind would consider cardiopulmonary resuscitation to be a reasonable, humanitarian act to perform on a patient, whatever age, with widespread metastatic disease nearing the end of his or her life?

Central to the ethos of my research group is the premise that patients have a right to honest information, to discuss their concerns and worries about death, and to choose where they die, with the appropriate care and support. I do not think that this should include hypothetical discussions about a management that most would agree to be inhumane. Any armchair ethicist who suggests that these conversations should take place with dying people should try doing it.

The guidelines and directives might well be appropriate for some situations, but I wonder just whose interests are really being served. If it is indeed necessary to have do not resuscitate preferences recorded in the hospital notes then such sensitive and distressing issues should not be left to untrained junior doctors.