Young People and Difficult Subjects
I have just got back from one of the more challenging Youth meetings I’ve been to.
I’m currently teaching a small group of our members about what is involved in going on duty. A bit on Event Management, a bit on Risk Assessment, some duty planning. Nothing particularly controversial or difficult. Today, one of the things we discussed was conduct on duty.
It was all going fine. We had the normal things like being respectful, and professional. I was pleased to see a note mentioning about patient consent, something some adults tend to forget about, and was surprised to have someone mention mental capacity. Most of them didn’t know what this meant, so I explained how, before we allow a patient to decline treatment, we have to ensure that they are in a fit state to make that decision. It can be quite black and white (i.e. fully aware patient: full capacity, unresponsive patient: no capacity). However, there are also a million shades of grey that can easily trip you up if you’re not careful. I explained this to them all, and how, for example, a young child is not normally considered to have capacity. This of cause raised the issue of people with mental disabilities, so I had to explain that as well.
This wasn’t going quite to my plan, but they were all listening, and asking the questions in a sensible manner, so I didn’t foresee any reason not to allow it to continue. Yes it’s a difficult subject to explain, but I think they understood.
That is, of cause, until one of them raised the issue of DNRs (Do Not Resuscitate orders). These are basically an advance decision made by the patient (or someone with suitable powers to act on their behalf) that instructs us to not attempt resuscitation if someone stops breathing. It is essentially an order to allow someone to go in peace if they’re dyeing. It is very uncommon to come across them in the first aid field (not least because most of our patients aren’t this unwell), and we don’t normally search for them. In all honesty, it has never really come up in my training. However, I do know enough about them to know that, if I know about a genuine DNR, I need to respect it.
This is difficult enough to explain to some adult members. The decision to just let someone go is very hard to make, and when we are trained to act quickly to save lives, it goes a little against the grain.
Now try explaining this to a small group of young people who are drinking in every word I say. I’ve let the conversation go this far, so I can’t really back out now, and I have no good reason not to explain. I just have to go for it. So I go on for a good ten minutes on what they are, when they are typically used, and explain how we have to respect a patients decision in these matters, no matter how hard it is. I’m honest, and explain how I would find it difficult to handle, and that I would never expect them to be put in that situation. I think they understood it.
I hope they did.
I also hope I can keep off of these subjects in the future.