Life at any cost
Should the cost of emergency care be considered when a patient's life is at risk? And what will this mean for the NHS?
Evelyn was in her 70s when she was taken to the emergency department after having a heart attack. Central to and beloved by her large extended family, they all waited at the hospital for news. Her daughter Eleanor told me what Evelyn was asked minutes after hearing she’d had a heart attack.
'They asked her whether she wanted to be resuscitated. She said yes and was then asked: "Are you sure? It could break your ribs." She said yes again. They kept detailing the terrible things that could happen if she agreed, until I intervened to point out that she had repeatedly said yes. It was as if they didn’t want her to live.'
'They said, in effect, that care costs money and the trust was not wealthy, and that a do not attempt resuscitation (DNAR) is a medical decision.' Eleanor recounted how her family was made to feel like her mother wasn’t as worthy of resuscitation as a younger person. She wondered what would happen if the doctors felt her mother’s life – an active life filled with love and quality – wasn’t worth the price tag.
Investing in life
Our NHS is also a 70-year-old grande dame who, beloved by her large extended family, is full of love, activity and quality but with problems caused by her frailties. Like Evelyn, she is still alive and not ready for the final sleep. Is it also true that, like Evelyn, some question if the cost is worth it.
Who will decide if the NHS should be DNAR? Will those who have the most to lose be heard before it’s too late? Eleanor held the doctor accountable for decisions about her mother's care; who will be held accountable if the NHS is allowed to flounder?
Evelyn is holding her own, by the way, after a bit of investment in her survival. Will the NHS be so lucky?
Bethann Siviter is an independent nursing consultant