Doctors in Unite reiterate our opposition to any scoring system being used as a blanket cut-off to people accessing hospital care. We understand that conversations with patients about their wishes with regard to treatment and end of life care can be very helpful to ensure dignity in dying, but these must be undertaken with the utmost sensitivity, and with the best interests of the patient and their loved ones at its core. These conversations must never be a means of rationing care or of ticking a box in a care plan.
We are increasingly concerned to hear of incidents across the country during the COVID-19 pandemic, where patients who score above a threshold on various frailty indices have had conversations with health care workers in which the patient felt pressurised to agree to a DNAR and to give up the right to be admitted to hospital. Health care workers often feel that they are responding to official guidance and that they have no choice but to comply. This is fundamentally wrong. Health care workers must always place the interests of their patients as their main obligation and duty.
Of course not everyone will benefit from intensive procedures such as ventilation, but even the most frail may benefit from less interventionist treatment such as specialist assessment, symptom control, antibiotics or oxygen. It has been reported that the bed occupancy in some NHS facilities is lower than usual. Despite this thousands of people are dying in care homes, some of whom may have benefitted from hospital admission.
We restate our conviction that every life is of equal value. There must be no arbitrary thresholds above which treatment is withheld, and no one must feel coerced into forgoing treatment which is their right out of guilt that there are not enough NHS services to go around, especially when there is reported to be capacity in NHS hospitals.
Dr Jackie Applebee is the chair of Doctors in Unite