Is it acceptable for doctors not to attempt to save a life? Is it okay for doctors to decide ahead of time, whether a patient who goes into cardiac arrest, should be resuscitated or admitted to intensive care? And furthermore, not make the patient or their families aware of this decision? On Sunday, Jan. 16th, the Danish TV2 News (TV2 Nyhederne) ran a story that has since sparked a major and hefty debate in the country.
The story exposed what doctors at Herlev Hospital had written in the records of an 82-year old, lung-disease patient, Lilly Hünemoerder. Evidently they had written that neither resuscitation nor admittance to the intensive care unit should occur in the event of Lilly suffering heart failure. This was in direct contrast to Lilly’s own wishes. Doctors had made a predetermined life-or-death decision, without discussing or sharing this with the patient or the patient’s relatives.
According to TV2 News, approximately every fifth patient at the lung-medicine ward, where Lilly was admitted, had medical records inscribed with the ‘codes’ Minus EHM or Minus ITA. These codes basically instruct hospital personnel not to resuscitate or administer intensive care to a patient in the case of heart failure.
However, the issue is not the fact that that these ‘codes’ are entered in the journals. Keep in mind, that there are also patients who are terminal and, therefore, do not wish to receive help in prolonging their life. There are also cases where a patient’s quality of life would be severely compromised if further treatment were given, so the decision to discontinue treatment is the best one. The real and important issue is whether a patient has the right to be asked and has the right to know about the decision in advance.
The case has sparked debate because it is thought provoking and worrisome that such a critical decision can be entered into a patient’s records without the doctor having talked to the patient (or the patient’s relatives) about it first. Legal experts say that doctors violate healthcare legislation when they fail to do so.
Kent Kristensen, a legal expert from the University of Southern Denmark, told TV2, “Not informing the patients like this is clearly illegal. It is a violation of the patient’s right to self-determination.”
The big questions that now arise because of the TV2 news story are: Do doctors provide sufficient information to their patients and or relatives? On what grounds do and may doctors make a decision on who should live or die? What is the common practice at different hospitals in Denmark? The debate is on going and the Health Minister, Bertel Haarder, has been in contact with the National Board of Health about the issue and will conduct an investigation to determine if this practice is a common occurrence in hospitals. He intends to inform parliament as soon as possible on how the Board of Health will ensure that the rules of doctor-patient communication is to be applied. It will be an interesting debate to follow in the weeks to come, as the outcome could very well affect how doctors are required to communicate with seriously ill patients (or their relatives in cases where the patient is unable to) with regards to further life-sustaining treatment.