Death doctors and DNR

As we hear yet again from a patient who has seen the instruction "Do Not Resuscitate" scrawled on her notes, Peter White goes to the heart of what causes such dangerous presumption

It’s the stuff of idle banter at smart medical dinner-parties, or gossip in the sluice-room: those amusing little acronyms scribbled in the margins of patients’ notes. I don’t spend much time in sluice-rooms and am never invited to smart medical dinner-parties, so I forget most of them; but you know the kind of thing: Ch: Confirmed hypochondriac; Mm: Moaning Minnie; Aob: Awkward old bastard! Worth a quick snigger, perhaps, until you get to that insidious Dnr: Do not resuscitate, which can prematurely snuff out a life at the stroke of a pen. I’d like to add one of my own: Yas: You arrogant sods.

But the arrogance of the medical profession is a path much travelled in these columns, so I’d like to explore why this continues to happen, against the background of repeated assurances that it won’t.

There are people who have figured out how to live with the consequences of a condition or impairment; physical knocks, pain, feeling unwell, being ignored and under-estimated and, yes, the risk of death if something goes wrong. I think people who do this on a day-to-day basis, and who have built tolerance of it into their lifestyles, are beyond the comprehension of doctors, who are often used to dealing with people who regard perfect health as a constitutional right, and who often believe that doctors have godlike powers to deliver this: a belief which rubs off on the doctors themselves. My own blind­ness, with few other medical consequences, doesn’t qualify me for the group of disabled people I’m talking about, I know, but I get a sense of it every time I walk to work, bouncing off trees and newly-erected scaffolding, tripping up or down kerbs, or trying to effect a dodgy road crossing. These incidents aren’t life or death to me – except for the efforts of the odd lorry-driver – but I know that when the public see it they are horrified, and many feel an overpowering need to intercede, and stop it happening. The idea that it might just be a regular part of my life that I’ve come to accept is beyond them, and doctors are no different; apart from the crucial fact that they think they have the right to an opinion on the matter. And so it is with those whose disabilities  place them in mortal danger, and who therefore need medical inter­vention to help them. The problem: that doctors, look­ing at the rest of the medical notes, somehow can’t envisage that this is a life which has been crafted and sustained around the tolerance of risk, and the continued wish to go on exercising it. I’ve not even mentioned the obvious right to consultation, the right to self-determination, the right to respect: those should really go without saying. What would perhaps be more funda­mental is the under­standing that no one, not even doctors, have the knowledge to understand the value of another life.