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Talking about death is not outrageous—reducing it to a tickbox exercise is

BMJ 2014; 349 doi: (Published 29 August 2014) Cite this as: BMJ 2014;349:g5369

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Reducing what should be a sensitive discussion about death to a ‘tick-box exercise’ is wrong; in this case, in a survey as part of the unplanned admissions enhanced service, which intends to save the NHS money by decreasing hospital admissions. However, discussions about death are crucial in ensuring we give the best care to patients. As underwritten in GMC guidance, where CPR will not be successful “making and recording an advance decision not to attempt CPR will help to ensure that the patient dies in a dignified and peaceful manner”. In the Telegraph article, Peter Carter justly states that such sensitive questions should be asked by those who have already developed a trusting relationship with patients. However, in the modern healthcare system this is not always possible.

On medical admissions wards it is often necessary to discuss and make DNACRP decisions, despite not having a pre-existing relationship with the patient. It is therefore particularly tempting to brush the subject under the carpet due to fear of the reaction from patients and relatives (something not helped by the aforementioned article). However in my (though limited) experience as a junior doctor, when approached sensitively, the majority of patients and relatives greatly appreciate being involved in this decision, regardless of whether they have met you before. This is far better for patient care than side-stepping the issue until it is too late.

In summary: it is not feasible to expect that this subject will always be broached by a healthcare professional who already knows the patient, but ultimately with good communication skills, sensitivity and the best interests of the patient at the centre of the decision, it is still a good thing to talk about death.

Competing interests: No competing interests

01 September 2014
Hannah Mooney
Foundation year 2 doctor
Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB