The National Health Service appears to be in crisis.Despite billions of pounds having been thrown at it, Health Secretary Andrew Lansley says without urgent reform the NHS faces a £20 billion-a-year black hole in funding and a potential doubling of health spending.
Almost 4,500 patients are said to have been discharged from hospital severely malnourished last year, some having illnesses more commonly seen in famines in Africa.
Dehydration is said to contribute to the death of more than 800 hospital patients each year. A report by the Care Quality Commission said some doctors were having to prescribe drinking water for patients to ensure they were given enough to drink.
One, if not two giant care home companies are said to be facing financial meltdown, with the possibility of the Government having to provide a rescue package to save thousands of care home residents from being made homeless. Meanwhile there are reports of "barbaric" abuse of patients at a privately run care home, and a review of the Care Quality Commission itself following an apparent failure to act.
While all this is going on - and not necessarily in direct connection with the above - the Royal College of General Practitioners has drawn up a charter for the care of patients nearing the end of life.
GPs are to assist such patients to make a written record of their wishes, which will be kept on the NHS database of medical records now being developed. Ambulance staff and emergency doctors will then be able to know, for instance, as well as the GP, whether or not the patient wishes to be resuscitated. The patient's wishes will be binding.
The charter may have been formulated with good intentions, but I have serious questions about its implementation. What if the information is put on the computer database incorrectly? What if it is mixed up with another patient's records?
Patients are already able to sign an advance directive (also known as a living will) stating how they wish to be treated, including whether or not they wish to be resuscitated in a life or death situation. Doctors are obliged to follow such directives.
The whole idea of living wills is flawed. An incapacitated patient who has signed a living will is not able to change his mind. How he feels when illness strikes may be very different from what he said when he was fit and well.
I recently heard of a case where doctors dealing with a life and death situation were told there was a living will and allowed the patient to die. It was later found that what was in the patient's medical records was a blank living will form that had not been filled in.
My position regarding future treatment is clear: I do not wish to be allowed to die with dignity; I want to be allowed to live with dignity until death finally and naturally intervenes. Some people who feel as I do have made living wills saying they do want to be resuscitated. I would be most reluctant to do that. Suppose my instructions were misinterpreted or misunderstood?
A doctor's calling is to save life. Unfortunately, a patient's autonomy has become the be-all and end-all.
