The daughter of a woman who was ‘bounced into’ agreeing not to call an ambulance for herself if she gets coronavirus has accused health chiefs of operating a policy of ‘pre-emptive eugenics’ across the country.
Maggie Ilsley said she wanted to warn elderly people and their families across the country that this is happening, after her mum was left ‘white as a sheet and shaken’ following an unexpected call from her own GP, who persuaded her to ‘not trouble the NHS’ in the event of her contracting coronavirus.
She said her mum, Margaret Emerson, was taken through a lengthy questionnaire process over the phone, and only at the end of it, did she realise she’d actually agreed to not call for an ambulance and to ‘die at home’ if she contracted coronavirus.
The 74-year-old grandmother suffers from an existing condition – COPD – and has been ‘shielding’ at home with no family visits.
But last week, she received a call out of the blue from her own GP, at the Courtside Practice in Yate, near Bristol, who asked her a series of questions about what she would prefer to happen if she contracted coronavirus.
Health chiefs in Bristol, where the call took place, have apologised for the way in which the call was handled, but declined to answer specific questions about the wider practice put to them by Ms Ilsley and Bristol Live.
Answering a question about the practice at the Government’s daily press conference on Friday, chief nurse Ruth May appeared to denounce the practice of using ‘Covid-19 as an excuse’ to have conversations about whether those elderly or vulnerable patients should be asked if they agree to not receive treatment, but did not seem to be aware that doctors’ surgeries appear to have begun doing just that anyway.
Maggie Ilsley posted her mum’s initial experience on Facebook, and said people commenting were so taken aback by what is happening to older people with pre-existing health conditions, that many did not believe it and told her the call must have been some kind of scam.
“She had no warning about the call, and no idea what it was really about until it began to dawn on her from the questions the doctor was asking her,” said Maggie.
“It was about what kind of care would she receive, and she signed that she’s not going to have an ambulance called out. It was framed for her as a choice between dying alone in hospital, or dying at home with her family there.
(Image: Maggie Ilsley)
“Given it was framed like that, she thought that she would rather die at home, but only afterwards did she realise the implications of this. At the moment, she’s isolated at home and we’re not visiting, as I’ve got a child with Down’s Syndrome, who is vulnerable himself.
“We’re checking in with her, of course, but effectively she felt she was bounced into agreeing not to trouble the health service and die quietly at home, alone, if she got this virus,” said Ms Ilsley.
“She was white as a sheet afterwards. She’s normally a strong woman. She’s got this COPD, but she’s had it 20 years, and doesn’t need oxygen, is normally an active person and it’s managed by drugs. She’s the rock of our family, and certainly not someone who you’d describe as unwell or nearly dying anyway,” she added.
After the call, Ms Ilsley said her mother called back and demanded to know what she’d just agreed to sign up to, and asked to see a transcript of the questions she was asked and what was recorded as her answers.
Meanwhile, Ms Ilsley said she had found other reports from around the country expressing concern, and realised it was a nationwide thing – elderly and vulnerable patients being called to ask to agree not to call 999, an ambulance or attend hospital if they contracted coronavirus.
She said the health professionals and politicians were mistaking the issue – and trying to couch it in terms of existing conversations patients have with doctors about a thing called DNRs – Do Not Resuscitate – requests.
What did the Chief Nurse say?
When asked in the Friday afternoon Downing Street press conference about the issue, the chief nurse Ruth May said it should not be happening.
“My clinical colleagues have these discussions all the time with patients and their families, thinking about their wishes, thinking about what care they have planned and that’s right and proper, but Covid-19 should not be used as an excuse to do that quite separately,” she said.
But Ms Ilsley said that is exactly what is happening – and she wanted to warn elderly people and their families that this is what doctors and GP practices across the country are doing right now.
“My mum has never had this conversation before, and she is nowhere near poorly enough to need it right now if it wasn’t for coronavirus,” she said.
“This needs to be highlighted. I want to warn people that these questionnaires are out there, that these doctors are basically trying to get the elderly to agree to die quietly at home or in a nursing home.
“It’s absolutely shocking. My mum is such a selfless person, that if it was put to her she wouldn’t want to take up a bed from someone else, and this is the problem. She was bounced into this. There will be tens of thousands of people who agree to this, without realising what they’re agreeing to.
“If it’s happening to my mum, then it will be happening to people who are far less likely to question it.
“She’s only 74. She’s an active and valuable member of society. She’s not so ill she needs oxygen, she doesn’t even need help to get upstairs or anything, but according to this, she’s so bad it’s already been decided she should be left to die without getting treatment that might otherwise save her – it’s pre-emptive eugenics,” said Ms Ilsley.
Maggie said she had many unanswered questions about what the agreement not to call 999 meant.
“Does it mean she shouldn’t call 999 for something else? Say she fell over and broke her leg, should she not call it for that? What if she had something else that wasn’t coronavirus – like a heart attack or chest pains? How do they know she’s got coronavirus if they aren’t going to come out and test her?” she asked.
What did the health service say?
Bristol Live put a series of questions to the Bristol, North Somerset and South Gloucestershire Clinical Care Group, the NHS organisation that manages GPs’ surgeries in the Bristol area.
- We asked if questionnaires were being sent in the post, or being done over the phone by doctors, and which was seen as the best practice?
- We also asked what the response of the doctor is if the person being asked is adamant that they do want to call 999 and do want to be treated?
- We asked if the aim of the GP at the start of the questionnaire process is to get the patient to agree to remain at home in the event of developing coronavirus?
- We asked what guidelines have been issued to GPs undertaking this process?
- We had questions about the implications of the ‘do not call an ambulance’ decision. Does it apply to other emergencies and other health conditions that are not coronavirus, and who decides if the patient concerned has coronavirus if they are not tested?
- We also asked what the criteria is to get patients to fill in these forms, and who decides?
Bristol CCG opted not to directly answer those questions, but instead issued a statement.
The statement, from Dr Martin Jones, the medical director at Bristol, North Somerset and South Gloucestershire CCG, appeared to directly contradict the chief nurse’s statement that Covid-19 should ‘not be used as an excuse to do that separately’.
He said the questions were part of a thing called the ‘ReSPECT’ framework – which stands for Recommended Summary Plan for Emergency Care and Treatment.
He said: “We are very sorry to hear about this patient’s experience, and we are following up with the practice.
“ReSPECT is a framework which is routinely used to guide an informed discussion about people’s choices and preferences in the event of a medical emergency.
“Given the current covid-19 situation, it’s important that as far as possible we understand people’s wishes in relation to treatment if they become acutely unwell.
“However, ReSPECT discussions should take place in a compassionate and sensitive way, that allow people and their families to reflect on their options and have their concerns listened to,” he added.
“It’s also important to make clear that ReSPECT is not a binding document. It is a record of someone’s feelings at the time the discussion took place, and should be a starting point to help clinicians, patients and families to make decisions about effective treatment in an emergency,” he said.