Under certain circumstances, living wills or advance directives may carry legal force in the UK. This paper traces the development of advance directives, clarifies their current legal position and discusses potential problems with their use. Case histories are used to illustrate some of the common dilemmas which doctors may face.

Adolescent↗

PubMed1997

Resuscitation witnessed by relatives. Might lead to a complaint for breach of confidentiality.

Explore the source record for details and available documents.

Confidentiality↗

PubMed1996

Resuscitating the elderly: what do the patients want?

OBJECTIVES: To study the resuscitation preferences, choice of decision-maker, views on the seeking of patients' wishes and determinants of these of elderly hospital in-patients. DESIGN: Questionnaire administered on admission and prior to discharge. SETTING: Two acute geriatric medicine units (Southampton and Poole). PARTICIPANTS: Two hundred and fourteen consecutive consenting mentally competent patients admitted to hospital as emergencies. RESULTS: Resuscitation was wanted by 60%, particularly married and functionally independent patients and those who had not already considered it. Not wanted resuscitation was associated with lack of social contacts. Sixty-seven per cent welcomed enquiry about their preferences and 78% wanted participation in decision, 43% as sole decision-maker. Wishing to choose oneself was associated with not wanting resuscitation, prior knowledge of it, and lack of a spouse. Patients' opinions remained stable during their admission. CONCLUSIONS: Discussion of resuscitation is practical on hospital admission without causing distress and the views expressed endure through the period of hospitalisation. Elderly patients' attitudes depend partly on personal health and social circumstances. This may assist doctors when patients are unable to participate themselves.

Aged↗

PubMedDate not supplied

Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores.

The aim of the study was to assess the usefulness of three different morbidity scores in predicting unsuccessful resuscitation. We reviewed the records of adult patients who underwent CPR between September 1994 and June 1996 in The Royal Hampshire County Hospital, Winchester. Demographic data and enough clinical data to calculate the Pre-Arrest Morbidity score (PAM), the Prognosis After Resuscitation score (PAR) and the Modified PAM Index (MPI) were collected. During the study period 264 consecutive adult patients underwent inpatient CPR. Twenty-eight (11%) of the patients survived to discharge from hospital. Patients who died had significantly higher morbidity scores than those who survived. No patient with a PAM score greater than 6/25, PAR greater than 7/28 or MPI greater than 6/24 survived. There were 47/264 patients who scored above this threshold for the PAM score giving a sensitivity for predicting unsuccessful CPR of 20%. The sensitivity of the PAR was 29% and MPI was 22%. Each score identified a different group of patients for whom CPR was unsuccessful. Using all three scores in combination identified 42% of the unsuccessful CPR attempts. Morbidity scores are likely to need further refinement in order to be a useful bedside tool for predicting success for individual patient resuscitation attempts.

Adult↗

PubMedDate not supplied

Do general practitioners know when living wills are legal?

BACKGROUND: There is growing public awareness of living wills or advance directives. Patients who wish to make advance directives may approach general practitioners (GPs) for advice. However, many GPs are unaware of the correct legal status of living wills. METHODS: Questionnaires were sent to 270 GPs in London and Winchester, asking seven questions about the current legal status of living wills. RESULTS: Of the 214 GPs (79%) who returned questionnaires, only 104 (49%) were aware that some types of advance directives could carry legal force. Many of the GPs who did know that living wills could be legally binding were unable correctly to answer further questions on the practicalities of the law; for example, 26% were wrong in believing that a lawyer had to draw up a living will, and 13% incorrectly believed that a doctor was legally required to give any treatment requested by a patient in a living will. CONCLUSIONS: Half of the GPs surveyed were unaware that living wills currently have legal force and most of the rest were unaware of important details of the law. More attention needs to be given to the education of doctors in this area.

Advance Directives↗