Patrick Harvie MSP and the Holyrood parliament.
By Bill Heaney
Green Party leader Patrick Harvie, pictured right, raised the controversial question of Do Not Resuscitate notices being issued to coronavirus patients in hospitals and care homes.
He told First Minister Nicola Sturgeon: “As well as wanting the people who are providing those services to be safe, people across Scotland are also concerned about the quality of care that their loved ones are getting.”
He added: “One of the issues that has been raised with me and other MSPs is that of instructions not to resuscitate a patient in certain circumstances—DNR notices, for short.
“We are all conscious that, in medical care, difficult decisions need to be made about the appropriate form of care for people if the worst happens.
“However, those decisions need to be taken in the context of a respectful discussion with patients and their loved ones, and in a way that respects the dignity and control that people expect to have in those circumstances.”
The former Dumbarton Academy pupil asked: “Does the First Minister recognise that, at the moment, that is not always happening in all circumstances, and that some people have been concerned at the perception, at least, that DNR notices are being issued on a blanket basis and without that respectful and calm discussion with individual patients and, where appropriate, their relatives?
The First Minister replied: “I have heard those concerns from some people, and I think that there are some cases of professionals trying to do the right thing but perhaps not doing so in the best way.
“Discussions will be taken forward between the medical professionals who advise the Government, including the chief medical officer, and—in this case—general practitioners, in particular.”
She added: “Coronavirus aside, we encourage health professionals to talk to individuals and patients about anticipatory care—about what all of us as individual human beings would want, or not want, if we were in the final stages of our lives.
“These are important conversations and they should be held sensitively and properly. They might ultimately come to the point of asking somebody whether they would or would not want to be resuscitated if they got to that stage.
“However, let me be clear: no one should receive a DNR form out of the blue without those sensitive discussions having taken place, and absolutely nobody should feel under any pressure to complete such a form. I want to be absolutely emphatically clear about that.
“We must continue to give people the best care that is available for them and the care that they would think is right for them. Sometimes, that will mean respecting people’s wishes about not wanting continued medical intervention, but those conversations must be held sensitively and we must always respect people’s wishes.”
Patrick Harvie asked if the FM could give an assurance that care homes, for example, and the medical professionals who work with them, would be reminded of “the absolute need to continue to respect, as we normally do, the requirement for those long-term and sensitive discussions with individuals to take place?
“Can she give any advice to anyone who is concerned that their family member or loved one has not been treated in the way that they should have been in relation to the notices?”
The First Minister said: “My main piece of advice is that nobody should feel under pressure to sign something of that nature if they do not feel comfortable signing it, or they feel that they have not had the right advice about it.
“If people feel aggrieved that they have received letters like that, they can take that up through their health board. We will take steps to disseminate that advice and information more widely to GPs and care homes.”
She added: “It has been suggested to me that, almost on a blanket basis, people in care homes contracting the virus will not be taken to hospital.
“I want to be clear that people—anybody, of any age, no matter where they are living—should get the care that is right for them, and if that means their being in hospital, that is where they should be.
“It will often be the case for an older person that the best and right place for them to be cared for is in their homely setting, but if they need to be in hospital, they should be in hospital, because the NHS is there to provide the appropriate and best-quality care for everyone.”