Tracey v Cambridge University Hospitals NHS Foundation Trust and Others: A Patient's Right to be consulted

The rights of patients in the UK today are horrifyingly limited but at least the court recognised here that they should be consulted when their medical team presumes to take life or death decisions on their future healthcare.

Although, it could, and has, give rise to endless debate, the merits of whether or not to undertake CPR (cardio-pulmonary resuscitation) was not the main issue in this case. The crux of the judgment is that Mrs Janet Tracey, who although very sick (she was badly injured in a car crash and had been diagnosed with a terminal brain tumour), was fully aware and cognisant was not consulted or involved in the decision making process when a Do Not Resuscitate (DNR) order was placed in her file by her doctors. And, by the way, neither was any other member of her close family who were almost constantly at her bedside.

Doctors in the UK are treated like minor deities. They are a scarce resource, if not always well paid. Most of them, I know from personal experience, are approachable, humane and decent, some, however are arrogant and overbearing and not a few are woefully ignorant about ethics and the rights of those in their care. Needless to say the courts almost always bend over backwards to accommodate them. But in this case judge recognised that they may have gone too far:

There is nothing in the medical/nursing records which suggests any agreement to DNACPR by Mrs Tracey...  If Dr L. had such a conversation, it would have been of importance to note the same both on the DNACPR Notice and in the medical records. I am unable to accept that the absence of such a note is a result of no more than poor record keeping.

(emphasis mine) 

And, even more damningly:

I am unable to accept Dr L’s evidence that he spoke to Mrs Tracey about resuscitation prior to the implementation of the first DNACPR Notice.

So god 0, patient 1, then; perhaps this is a good beginning, the recognition that a doctor does not have the right to unilaterally take a decision on the patient's behalf if the patient or their family are capable, they must and should be involved in the decision making process.

Don't get me wrong, It is completely understandable that many people would rather delegate full decision making responsibility to their medical team, that is their choice. However, not all of us feel the same, and it should never be forgotten that in any civilized society the patient's decision as to their level of involvement must always be respected. 

In my view, further progress needs to be made we should be moving towards a position where the doctor needs to obtain the patient's consent to make such a decision in the first place, hopefully, Mrs Tracey's case is a first step in that direction.

Thalidomide: Long Shadows

My mother had a stillbirth, two years before me, in 1961, it was her first pregnancy and she suffered horribly from morning sickness her GP gave her some meds for it... That's right, thalidomide, my elder sister died in utero and my mother had to bear her full term knowing she was dead. She was born deformed and the midwife informed my mother of her sex.

It's fair to say that my mother has always been defensive towards me, I used to interpret it as coldness. My father on the other hand cherished me. My two brothers were equally loved.  

I guess since they were born after me and male they didn't come with the baggage I did she could let down her guard a little and be the mother she really wanted to be and was.

Much later on when I had a serious illness my mother phoned from abroad "If you want, Tony (her partner) and I can come and stay with you".  Basically I told her not to bother. If my father had been alive, I knew, he wouldn't even have asked, just jumped on the first plane.

Once I was better I talked this thing over with a psych and basically gave her the reading I made of the situation above.  Psyche's response was "You should be doing this job..."

We get on all right nowadays.  We are mostly civil to each other, but our relationship will always be fraught. We live in different countries, Tony and my husband act as intermediaries and very good they are at it, too.

So yes, these things do overshadow the living to some extent, but hey, that's life.