BURY health bosses have re-affirmed their policy of giving certain patients the right to make a critical "life or death" decision.

The patient's wishes will be uppermost before consultants decide whether to issue "do not resuscitate" (DNR) orders should the patient suffer a cardiac arrest.

Bury Health Care NHS Trust chiefs have drawn up a revised DNR policy which will be worded in such a way as to avoid any confusion.

The new policy, put together by a team of health professionals, has been circulated to staff during a six-week consultation period.

The move comes four months after the Trust was embroiled in controversy when it was claimed that an 85-year-old man was "left to die" because his bed was needed for another patient.

Consultant anaesthetist Dr Kalpesh Pandya, who ran Bury General Hospital's intensive care unit, claimed Mr Ludwik Rothe's ventilator was switched off without all necessary tests being completed.

Mr Rothe, of Bury, had been admitted to hospital in February with heart and breathing problems.

Now, however, the revised procedure is aimed at underlining when such a DNR order is appropriate, given the health of the patient and his or her future prospects. One of the architects of the new policy is Mrs Angela Abbott, Trust executive nurse director and community general manager.

She said: "If you or I went into hospital and, God forbid, suffered a cardiac arrest, then we die.

"What happens then is that a resuscitation team is called and we're shocked in an attempt to get the heart working again." But in some cases, she admits, such revival procedures would not be appropriate.

"We're talking about people who suffer that kind of natural death and whose quality of life would not benefit in any way from being resuscitated," she explained.

Mrs Abbott cited the plight of her late father who was taken to hospital after collapsing.

"By the time his heart was returned to normal, he had suffered brain stem death and there was no mental function. It would have been pointless to resuscitate him.

"But that doesn't mean to say he wasn't given any other care. There are other instances where a recovery would not be acceptable to the patient."

Very often, the critical resuscitation decision is reached either in discussion with relatives or sometimes with the patients themselves.

The revised policy states that among the circumstances appropriate for considering such an order are whether the patient's condition indicates that resuscitation is unlikely to be successful and where such action is in accordance with the wishes of a mentally competent patient.

Another crucial aspect is where successful, the resuscitation is likely to be followed by a length and quality of life that would not be acceptable to the patient.

Mrs Abbott added: "If a patient said they did not want to be resuscitated, and they were fully competent to make that decision, then it would be documented and their wishes respected.

"But if a patient has made no indication of that nature, then we will automatically resuscitate.

"A DNR order is not the rule, but the exception. It is not done lightly," she added.

Although the overall responsibility for a DNR decision lies with the consultant in charge of the patient's care, his or her relatives' views will be considered. "When this issue is discussed with relatives, generally there is an acceptance that it is the right decision."

However, Mrs Abbott said it could work the other way with a consultant not placing a DNR order on someone whose relatives feel should not be resuscitated.

"It can work either way," she said.

The Trust's decision to revise its existing policy follows a recent British Medical Association conference where more guidance over DNR policy was recommended.

"We did have a policy in existence. But we decided to revise it in the light of the conference," continued Mrs Abbott.

"In previous times, there was always tacit agreement between doctors, patients and relatives whether someone would be resuscitated.

"But that's not good enough. We have to formalise it and properly document it."

Asked how staff had reacted to the updated version, Mrs Abbott said: "The new one has been welcomed as being more clear.

"Anything which makes difficult issues clearer must only be helpful and a good thing."