David Oliver: Allow nurses to use their professional judgmentBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m608 (Published 19 February 2020) Cite this as: BMJ 2020;368:m608
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The loss of a valuable nurse because of an irrational decision by the Nursing & Midwifery Council is a shameful event (BMJ Feb 2020 368:283). I agree with David Oliver that this will damage nurses’ confidence in the NMC and increase the number of inappropriate CPR attempts. We have seen the same punitive attitude from the GMC, with a similar inability to perceive the bigger picture.
It continues to surprise me that it should be thought sensible or dignified to inflict CPR on a dying person. It seems that the protocol in care homes has not improved since I was working as a vascular surgeon, when many times a dying resident of a care home was blue-lighted into hospital, in order to die on our wards rather than in the comfort of their own bed.
I would like to reinforce the plea for appropriate care for people according to their stage of life. We must reintroduce the idea that people have different phases of their life. One of them is dying, which cannot be reversed.
The quality of our death is as important as anything else for us and our families, and how it is managed can ease grief. A caring nurse using his or her professional judgement can help to provide this, and this seems to me to be the prime obligation.
When and if I become frail enough to enter a care home, my hope is for a calm and comforting place to end my days, uninterrupted by CPR, trips to hospital or antibiotics for pneumonia.
We have seen for the past few decades that modern medicine, for all its brilliant achievements has lost its way - lost its caring, its balance and professional judgement. Restoring this is urgent. It needs to be part of a wider debate on the direction of medicine, and how to deal with all the irrational and unrealistic expectations of it.
Competing interests: No competing interests