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Sir, I was dismayed to read the recommendations of the American
Medical Association on end of life care (BMJ 1998; 318:690) for two
reasons. Firstly, they demonstrate how far the relationship between
doctor and patient has moved from one of trust to one of suspicion and
legalism. Secondly, they are byzantine in their complexity.
I was director of an intensive care unit for many years where
decisions about futile treatment were common. The key thing was to have
established a relationship of trust with both the patient and the family
from the time of admission to ICU. Almost always decisions about the
direction of care could be made by patient discussion with the patient (if
they were competent), the family and all the members of staff involved in
their care. Of course, even after the introduction of outcome scoring
systems it was not a exact science. At the end of the day we all had to
come to a judgement. The reality is that we cannot do betteer than that.
If facilitators and committees have to brought it then the relationships
between everyone concerned have broken down.
Doctors have a duty to protect a patient's natural rigth to life and
their natural right to die. Our diagnostic and therapeutic knowledge
should be used to distinguish between the two and advise patients and
their families accordingly.
John Searle
Consultant Anaesthetist
Royal Devon and Exeter Hospital
Exeter EX2 5DW
AMA guidelines on end of life care
Sir, I was dismayed to read the recommendations of the American
Medical Association on end of life care (BMJ 1998; 318:690) for two
reasons. Firstly, they demonstrate how far the relationship between
doctor and patient has moved from one of trust to one of suspicion and
legalism. Secondly, they are byzantine in their complexity.
I was director of an intensive care unit for many years where
decisions about futile treatment were common. The key thing was to have
established a relationship of trust with both the patient and the family
from the time of admission to ICU. Almost always decisions about the
direction of care could be made by patient discussion with the patient (if
they were competent), the family and all the members of staff involved in
their care. Of course, even after the introduction of outcome scoring
systems it was not a exact science. At the end of the day we all had to
come to a judgement. The reality is that we cannot do betteer than that.
If facilitators and committees have to brought it then the relationships
between everyone concerned have broken down.
Doctors have a duty to protect a patient's natural rigth to life and
their natural right to die. Our diagnostic and therapeutic knowledge
should be used to distinguish between the two and advise patients and
their families accordingly.
John Searle
Consultant Anaesthetist
Royal Devon and Exeter Hospital
Exeter EX2 5DW
Competing interests: No competing interests