Major inconsistencies in the use of the ‘do not resuscitate’ order have been found in England’s care homes during the COVID-19 pandemic. A report that has been published by the Care Quality Commission (CQC) found that, in some cases, care home staff were ordered to write a blanket ‘do not resuscitate’ into all patient’s records without prior discussion with family members.
Our specialist solicitor Nimish Patel commented that: ‘Whilst it is understandable that GPs and care homes were considering the potential overloading of hospitals during the pandemic, they should also remember the importance of providing full information during end of life care in order to enable vulnerable patients and their families to make an informed decision. We do not want to go back to the times of the Liverpool Care Pathway , where those in end of life care were becoming little more than a tick box exercise. It is also a potential concern as to whether the DNR notices have now been taken from the patient’s records or explained to the patients otherwise they may still be in force even at this time.’
What does ‘do not resuscitate’ mean?
A ‘do no resuscitate’ order (DNR) is a legal order that indicates that an individual does not want to receive cardiopulmonary resuscitation (CPR) if their heart stops beating. In some cases, it can also be used to block other forms of medical intervention that could save the life of the patient.
There are some misunderstandings in relation to the law surrounding the use of a DNR order, but the law does not actually require a patient or their family to consent to a DNR order. This means that a doctor can technically issue a DNR order without consent, but the law does still limit the use of DNRs in certain circumstances, and it also gives patients a right to be involved in the decision-making process.
In relation to DNR decisions, the law requires the following process, and family members of the patient should be involved unless a patient has asked for them to be excluded.
- If a medical professional has determined that a patient is likely to stop breathing or their heart is likely to stop, then the patient and their family should ideally be made aware that this treatment may be the best course of action and that it will not affect other treatment decisions.
- The patient should be informed of all of the information in regard to a DNR order and how the decision has been made. If a patient and/or their family does not want to discuss the matter further and want to place responsibility with their medical care professional, this can be confirmed and recorded in medical records.
- If the patient does want to have a more detailed discussion with their doctor about the decision to issue a DNR order, they have a right to know all the medical reasons behind the decision.
- If the patient disagrees with the decision, then they are entitled to request a second medical opinion, but they cannot legally overrule a DNR if it is deemed the best medical decision.
The only specific circumstance in which a patient may be removed from the discussion about their DNR is if their medical professional reasonably considers that involving them would cause them psychological harm or distress.
What has the report found?
The report has called for improvements to be met in these areas after it found that:
- There were serious concerns about breaches of some individuals’ human rights
- There was a significant increase in DNRs being put in place in care homes at the beginning of the pandemic, an increase from 16,876 to 26,555
- 119 adult social care providers felt they had been subjected to blanket DNR decisions since the start of the pandemic
- A GP sent a DNR letters to care homes, asking them to put blanket DNR orders in place
- In one particular care home, a blanket DNR order was applied to everyone over 80 who also had dementia
The lack of compassion in the decision making during the COVID-19 pandemic is concerning, and the chief inspector of primary medical services at the Care Quality Commission, Rosie Benneyworth, has said that ‘ It is vital we get this right and ensure better end-of-life care as a whole health and social care system, with health and social care providers, local government and the voluntary sector working together.’
Here at AWH, we are passionate about making sure patients are supported throughout their time under medical care, and that they are always aware of what they can legally expect from their healthcare professional. If you or a family member are concerned about medical decisions that are being made surrounding end-of- life care, then we can provide legal support to make sure you know where you stand.Get in touch
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