What Would You Do?
It is my experience that the do not transfer to hospital wish us related to not wanting to die in hospital. It is not about not having treatment, even in these circumstances treatment should and can be sought as Sheryl states. It is important that we seek solutions to the presenting problems and that can be done in a number of ways. The main thing is to respect the stated wishes of the individual whilst seeking to make them comfortable and even in the best case scenario facilitating recovery. Be there for the person reassure them, give them respect, compassion and do not compromise their dignity.
WWYD. Respecting Final Wishes ⚖️
A resident is living with a terminal illness and has a completed ReSPECT form clearly stating “Do not transfer to hospital.”
One morning , their condition changes. They develop a high temperature (39.7°C), become delirious, and are no longer able to communicate clearly. They appear very unwell and distressed.
Some staff feel strongly that an ambulance should be called, saying, “We can’t just leave them like this.” Others point to the ReSPECT form and say, “These were their wishes — we need to respect that.”
The family is not immediately available, and the situation feels urgent.
What would you do?
• Do you follow the documented wishes, even in a crisis?
• Do you override the plan and seek emergency treatment?
• Or do you look for another way to manage the situation in the moment?
When someone can no longer speak for themselves, how do we balance prior wishes, current risk, and our duty of care?
I would respect the person's wishes and look for an alternative solution Provided the paperwork with the person's wishes had been witnessed correctly, I didn't have reason to suspect that the person had been forced or bullied into signing against their will.
I would also make sure with the manager that these wishes are the person's own wishes.
So in that situation I would check this with the manager especially as older people can be coherst
This has always been problematic, even setting aside my dislike of the ReSPECT form, because you can't forbid transfer to hospital with an Advance Decision - which only allows you to refuse a treatment.
In the end, it probably comes down to the staff already feeling certain that the patient would not have wanted to be taken to hospital in the situation: 'understanding imparting more confidence than merely reading a document'.
But if you are the patient, and you are worried about this while you are still capacitous, you can write an ADRT which refuses specified treatments if you are in a hospital: if you had forbidden the taking of blood samples if you are in hospital, along with other likely interventions, then [certainly if the ADRT is respected] there would be no point taking you to hospital.
But this, as with the refusal of CPR, is something where patients seem to be given the power to refuse future interventions, when in reality it will often/sometimes turn out to have only been 'seems to have been given' and not 'were given'. It is a problematic issue.
At the heart of this type of issue, is this question:
How, from a legal perspective, does/should the reader of a ReSPECT form utilise the recommendation/s recorded on the form, during the reader's decision making?
It is the answer to that question, which caused me to avoid 'making recommendations' on my proposed different version of CPR/DNACPR documentation:
I used to come across stories about loved-ones who were dying at home, and who had a core-objective of dying at home, and whose live-with relatives were trying to facilitate that desire, having some sort of medical issue when close-to-death, 999 becoming involved and the patient 'being scooped up and taken to hospital' - then, the hospital saying what amounted to 'Your dad is too ill for us to risk transferring him back home, because he could die in the ambulance'. That was/is deeply unsatisfactory, if you are the relative.
I will add, that when my mum was dying, her main objective seemed to be a determination to die at home.