Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.Setting—A large district general hospital in the United Kingdom.Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision (...) making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.Results—Twenty-four were inadequately informed of their illness.Forty-six said they would want to know were something serious to be found. Twenty-eight wanted to make their own decision if requiring risky treatment and 11 wanted family members involved. Thirty-one wanted to make a cardiopulmonary resuscitation decision and five of these decisions differed from those made by the doctors. Twenty-five preferred the doctors to decide. Eleven of the patients had heard of living wills but only one had executed such a will. Seven of the patients wished to provide advance directives. Three did not find the history taking helpful but none were discomforted.Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences. (shrink)

This edition of the journal includes, with an introduction and three commentaries, a recent joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing, on decisions relating to cardiopulmonary resuscitation (CPR).1 The statement was produced in response both to a professional need to decide when attempting CPR is and is not ethically appropriate, or indeed lawful (especially in the light of incorporation of the European Convention on Human Rights into UK law), and also (...) to public concern that such decisions have not always been made in concordance with the wishes of patients or people close to them. The guidelines it sets out reflect a broad consensus of current medicolegal views in the UK, include a variety of helpful and practical recommendations, and can be seen, in many respects, as a model of their kind. As a model of actual decision making however, they raise some problems. Model helps us understand the reality they represent by simplifying it, but in the process of simplification, aspects of the reality represented which do not fit in with the model may be left out or downplayed. Three such aspects identified by our commentators concern patient autonomy, quality of life judgments, and the role of families in decision making. In his commentary, Robin Gill argues that while “many of us cherish” the right to be properly informed before decisions about our treatment are made, such information “may become a burden for others when they are at their most vulnerable”. Being told about CPR, with the implication that a “do not attempt resuscitation” (DNAR) order is at least possible, may provoke “angst about death” in these vulnerable patients. The guidelines state that a competent patient's wish not to discuss resuscitation should be respected. But they also state that …. (shrink)