Writing a statement of wishes in case you get really ill

[Garysmum]

Read a thread on here where it was stated that certain people won’t be considered for aggressive treatment if they get seriously ill as their conditions mean it’s unlikely to be successful,
It made me think. I’m CV due to moderate asthma and being on immune suppressants for auto immune disease. If anyone just reviewed my drug list I expect they’d leave me to die.
But in the last 3 years, I’ve improved my asthma to the point of only using a preventative or inhaler in winter and I’ve got fit. I have low blood pressure, low cholesterol, low resting heart rate. I do 12 hours exercise a week and am very fit for mid 40s. I’m very fit full stop.
I was thinking about writing a letter of wishes as I want aggressive treatment if I get very ill. Im happy to provide my heart rate stats and exercise stats for a year. Whatever it takes.
Has anyone else had this thought?

[quote Mickarooni]@LindaEllen

Regardless of being fit and healthy, CPR on an 80 year old is brutal and unfortunately, unlikely to work. The trouble is, people think DNACPR means strong and healthy people won’t get treatment. It simply means that cracking their ribs is considered not an option.[/quote]
There was a really interesting program on radio 4 a few months ago about resuscitation, and how brutal it was and how often it was unsuccessful. I’m from a family of medics and I had no idea! I think films and TV give us an overly optimistic perception where everyone is revived after just a few pumps and is up and running about minutes later.

[quote Innocenta]@Mickarooni If you think that family and interpersonal pressure doesn't have some effect in real-world situations, you're being a bit naive. Many doctors are upfront about this in venues where they can speak relatively anonymously. [/quote]
What do you mean? Sorry, genuinely unclear. Of course family has influence but ultimately, if families and doctors disagree and the patient lacks capacity, it goes to court.

I'd always suggest that everyone make an Advance Decision about the sort of care they want if they are unable to communicate. However, it's worth being realistic about what this can and can't do.

Legally, you can withhold consent for treatment in advance. So you can say "I don't want CPR". "I don't want ventilation". "I don't want blood products".

You can't consent to treatment in advance. And you can't use it to force doctors to provide care they believe is hopeless or not clinically justified.

So, even if you have written you want ITU care, if it isn't clinically justified you will not be offered it.

An intensivist colleague has a poster which says, amongst other things, "CPR is not a cure for normal dying". It's worth remembering that. Modern medical care can achieve remarkable things, but it isn't a cureall, and sometimes the kindest thing to do is ease suffering and let nature proceed.

It's also worth having a discussion with your loved ones about what your wishes and preferences would be. As @Northsoutheastwest76 says, these differ between individuals. If they end up having to input into decision making it is hugely helpful for everyone - emotionally and practically - if they know what you would want if you were able to communicate.

And make sure, if you have written something, that everyone knows where it is! I have a copy with my will, and other family members have copies, too. It's no use if it's buried in your sock drawer and noone knows to look.

i think Mickarooni we aren't talking about the court based decisions but more like the every day /every week scenarios... I have seen plenty of cases where Dr's have continued to provide life extending treatments/care, based on family wishes rather than patients best interests, particularly with inexperienced /junior staff or Dr's who have strong beliefs about maintaining life whenever possible (...we had one GP who refused to have DNR discussions despite this being really important for terminal patients care ). Dr's are only human, there remains a lack of acceptance of death and lack of knowledge as to what it means to support people to live well at the end of life.

@s1h2o3na

i think Mickarooni we aren't talking about the court based decisions but more like the every day /every week scenarios... I have seen plenty of cases where Dr's have continued to provide life extending treatments/care, based on family wishes rather than patients best interests, particularly with inexperienced /junior staff or Dr's who have strong beliefs about maintaining life whenever possible (...we had one GP who refused to have DNR discussions despite this being really important for terminal patients care ). Dr's are only human, there remains a lack of acceptance of death and lack of knowledge as to what it means to support people to live well at the end of life.

I understand that but all I’m saying is that, ultimately, a statement of wishes doesn’t mean anything. It means even less in this context - a young, not that unhealthy person doesn’t need to say “please treat me” because they would!

Today 09:17 Innocenta

@NinaDefoe You're not reading her post in good faith, then

I’m not sure you’re reading the same OP as I am!
If anyone just reviewed my drug list I expect they’d leave me to die
The OP doesn’t trust the doctors and nurse to treat her.

The NHS has never run out of ventilators. This is absolute BS.

@SweetBabyCheeses99 yes it has

You probably won’t even need medical treatment let alone “be left to die”!

[quote RoyalFamilyFan]@SweetBabyCheeses99 yes it has[/quote]
@RoyalFamilyFan

Where? When? If there are no ITU beds, people get transferred to other hospitals. If they’d “run out” it would have been headline news.

They just cancel major OPS if no ICU bed is available.

@Mickarooni it was in the news