Ah - you are interested in 'remains' accurate?
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Replying to @MikeStone2_EoL @KaraChrome
Exactly! As opposed to the form being vulnerable to later amended, in order to try and justify any clinical action - or inaction - that was not in keeping with the consent obtained.
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Replying to @C7RKY @KaraChrome
Well - if you design a better form, you would have the problem of the entire form being substituted for a faked one. I suppose you would need to store copies of completed consent forms in a 'trusted third-party repository' as soon as the form was completed? Unlikely to happen.
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Replying to @MikeStone2_EoL @KaraChrome
3rd party not necessary. Some measures can prevent amendment, but the greatest protection comes from ensuring that the form makes it clear the pt should take their copy immediately after signing it, imho. Can't switch/amend it unnoticed, if the patient has a copy at home.
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Replying to @C7RKY @KaraChrome
Keeping a copy makes sense - but all of this (your issue) is about 'distrust' when you think about why it is necessary: distrust is a very poor foundation for good care/behaviour, especially during end-of-life at home [as I keep pointing out, in BMJ rapid responses].
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Replying to @MikeStone2_EoL @KaraChrome
1/2 You're right, this stems from being given reason to distrust, but it's also about regulation. My mother & I trusted implicitly however, as most do. And it transpires that it's possible to abuse that trust. Potentially systematically & at scale, when you look at the evidence.
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Replying to @C7RKY @KaraChrome
1/2 You cannot 'have a process to cover my major issue': an EoL patient at home, explains to a family carer late one evening 'I've now reached the point when I definitely don't want anyone to attempt CPR' but. before that has 'reached the records' the patient arrest and the
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2/2 family carer calls 999, explaining 'my dad made it clear to me last night, that he doesn't want CPR if his heart has stopped'. Either the 'mindset' is that 999 should believe the carer, or else not - currently it is 'to not believe the carer' which angers me!
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Replying to @MikeStone2_EoL @KaraChrome
To use your word from earlier - tricky. Not all families have the same dynamic, so protecting the pt's right to life over the undocumented word of a relative? Yeah... just tricky. Hopefully not too many happen in such a short window like that?
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Replying to @C7RKY @KaraChrome
The point is - listening to 'I really would prefer to be dead now. from your dying dad, 'has a deep impact on you': subsequently being 'accused of lying' by 999 leaves you rightly 'furious' if you are [and surely most would be] one of the honest family carers.
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I can entirely understand that. Fewer times can be more emotional in life already, without the added insult of such an accusation. I'm sorry if that was your experience.
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