The Gazette 1995

overlooking the Gulf of Mexico. Patrons and potential patrons can rest assured that solicitor, Ms. Lynch did not indulge in cooking any of the fare, nor tamper with the cuisine in any way, but merely used her solicitors experience to attract the casual passer-by! 70. Editorial The Lancet 341(1993) 1123. 71 . supra at 1124. See also the article by Ezekiel Emanuel in the 'Lancet', Jan 16, 1988 p. 106. 72. See Kjellstrand C.M. 'Who should decide Professionals' JAGS 36( 1988)840 it was found that patients believed that the doctor should initiate discussion, but doctors were reluctant to do so for fear of unnecessarily alarming the patient. 73. Stewart et al 'Resuscitation decisions in a general hospital' BMJ 30()( 1990)785. 74. In one UK survey 1 1% of patients for whom resuscitation was attempted survived to discharge. Keating 'Exclusion from resuscitation' 82( 1989) JRSM 402. 75. Torian et al 'Decisions for and against Resuscitation in an acute Geriatric Medical Unit' 152(1992) Arch Intern Med 561. See also Murphy et al The Influence of the Probability of Survival on Patients' Preferences' 330 (1994) N Engl J Med 545 where a study of elderly patients' attitudes to CPR after their doctors had informed them of the possible outcomes of such treatment showed that, whilst 41% had opted for CPR before learning of the probability of survival, this was reduced to 22% after such discussions. 76. Some research shows that surrogates tend about your death?' JAMA 267 (1992) 103 where a survey showed that 70% of patients interviewed wished to discuss the issue with their doctor, but only 6% had done so. In Kohn et al 'Life Prolongation: Views of Elderly Outpatients and Health Care

"Double Jobbing Solicitor" - Irish solicitor while on vacation in Florida acts as Sales Executive on behalf of her cousins, the Lynch sisters from Ballydehob, Co. Cork, who carry on a most hospitable hostelry on "Long Boat Quay" a sumptuous archipelago on the west coast of Florida, patient s ultimate condition. There are two possible results of discontinuance; either the patient breathes spontaneously and survives, or they die as a result of cardio- respitory failure. The decision is essentially a clinical one which the doctor makes on the basis of what the ventilation treatment can achieve for the patient. If ventilation constitutes non-productive treatment, then it can be discontinued. See generally Mason J.K. op. cit. at 46-7. 63. Airedale NHS Trust v Bland [1993] 1 All E.R. 821; Frenchay Healthcare NHS Trust v S |I994] 2 All E.R. 803. 64. BMA Discussion Paper on Treatment of Patients in Persistent Vegetative State, September 1992, quoted in Bland, fn 63 at 871. 65. R v Malcherek, R v Steel [ 19811 WLR 690. 66. John F. Kennedy Memorial Hospital v Bludwortli 452 So 2d 921 (Fla. 1984). 67. Mason J.K. op. cit. cites as examples Relman A.S. The Saikewicz decision: Judges as physicians' (1978) 298 New Engl J Med 508; Dunea G. 'When to stop treatment' (1983) 287 Brit Med J 1056. At the time of writing, November 1993, there have been no such applications in the courts as in the Bland case, fn 63. 68. Lappe M. 'Dying while living: A critique of allowing to die legislation' (1978) 4 J Med Ethics 195. 69. 'Butterworths Medico-Legal Encyclopedia' (1987) at 553. Our emphasis. 61. In re Eichner NYS 2d (App Div) 1980. 62. The decision rests on an assessment of the

For further infornmation please telephone (065) 77200 or (01) 2692126

to display a greater reluctance to withdraw treatment than the patients would themselves; Uhlmann et al "Physicians and Spouses' Predictions of Elderly Patients' Resuscitation Preferences' 43( 1988) J of Gerontology 115. Other research indicated that where decisions were made by surrogates, a greater number of patients were classified as DNR; Luce P. 'Cardiopulmonary Resuscitation in the Elderly' 47 (1993) BJCP 285. 77. Emanuel The Economics of Dying' (1994) N Engl J Med. 78. Luce P. toe. cit. 79. 'Variability in Physicians decisions on caring for chronically ill elderly patients: an international study' 144(1991) Can Med Assoc J 1133. 80. In a survey of doctor's attitudes towards such documents, it was demonstrated that the single most important influence on a doctor's decision to withhold treatment was the patient's self reported wishes; Miller et al 'Factors Influencing Physicians in receiving in-hospital CPR' 153( 1993) Arc/i Intern Med 1999. In an American nursing home where 76% of the residents

completed advance directives, one year after implementation it was found that deaths in the home had increased and deaths in hospital had decreased, along with a decrease in the mean length of hospital stays.

81. Kjellstrand C.M. Inc. cit. 82. 'Middlemarch'

(ed. Harvey W.J. 1965) at

186.

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