Damning evidence that hospitals are routinely designating elderly patients as "not for resuscitation" emerged last night as a leading charity prepared to hand a dossier to a government investigation.
Age Concern says that so far, it has details of 50 cases where patients' notes were marked "not for resuscitation" and believes that the cases, which have come to light in the course of just two days, are the tip of an iceberg.
Several hundred others are under investigation following last week's disclosure that cancer patient Jill Baker, aged 67, had been marked "not for resuscitation" on her case notes by a junior doctor at St Mary's Hospital, Portsmouth - a doctor who she claims never even examined her.
In the majority of the 50 cases the patient died after a "not for resuscitation" order was written into case notes without consent. Age Concern spokesman Andy Allsopp said: "It is clear there needs to be a root-and-branch review of the care old people receive in NHS hospitals. This is symptomatic of the age discrimination taking place up and down the country."
The case of Mrs Baker prompted an immediate inquiry by the Department for Health, which said her treatment was in clear breach of doctors' own rules. Guidelines from the British Medical Association state that such decisions must be based on the express wishes of the patient as well as clinical need. If patients are unable to speak for themselves, consent should be sought from a close relative.
"Not for resuscitation" orders rarely become apparent because case notes are not easily available and the orders are often written in coded language known only to hospital staff.
In one case, Brendan Moroney, a care worker, discovered the "not for resuscitation" order written on the case notes of his mother, Patricia, 75, at St Mary's in London. He scored out the letters "NFR", signed by a doctor, and wrote over them: "Oh yes she is".
Mr Moroney knew what NFR stood for because of his work nursing the elderly. His mother, who suffers from Parkinson's, was critically ill with a chest infection but is now back at home being cared for by her son.
A spokesman for St Mary's said quick decisions often had to be made on seriously ill patients when their families were not present, to allow them to die rather than put them through the agonies of cardio-pulmonary resuscitation. "He [Mr Moroney] saw the notes before we could discuss it with him," said the spokesman. "It is not a common occurrence [for people to read medical notes]."
Another case involved Southampton General Hospital which apologised yesterday to Doreen Feltham for its failure to consult her over the treatment of her 71-year-old husband. Mr Feltham, who was suffering from terminal cancer, died at the hospital of pneumonia in January. "We accept Mrs Feltham should have been consulted but was not when the trust first concluded that resuscitation would be inappropriate for her husband, as it would simply prolong his suffering," said a spokesman.
He said doctors faced a difficult decision in refusing treatment and allowing patients to "die with dignity". "Sometimes resuscitating people who are terminally ill with something else is unkind to them."
Dr Michael Wilks, chairman of the British Medical Association's ethics committee, has admitted the guidelines are not al- ways followed, but said he would be surprised if "there was an endemic habit on behalf of doctors making these decisions".
Dr Liam Fox, Conservative health spokesman, said: "I think the medical profession needs to work within clear guidelines. The Government has a duty, especially after Labour members killed off the anti-euthanasia Bill in the Commons on Friday, to produce clear guidelines as soon as possible. The medical profession does not always know best, and doctors cannot be allowed to play God without clear guidelines being set for them."
A spokesman for the Department of Health said it would investigate any evidence present- ed by Age Concern. "We will not tolerate any discrimination on the grounds of age. But a lot of these cases are down to poor communication. There are very clear guidelines, but they must be rigorously applied."
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