Do not resuscitate orders
25 May 2021 by Aaron Pottle
News stories about hospitals and care homes using ‘do not resuscitate’ (DNR) orders to ration healthcare and ‘write off’ vast numbers of vulnerable people have caused families a great deal of concern during the COVID-19 pandemic. How can you make sure the treatment your loved ones receive is in their best interest and when should you seek regulated legal advice if you have concerns? Following on from this week’s Law Society Solicitor Chat, Aaron Pottle from FJG’s Dispute Resolution team has provided some answers to a few frequently asked questions around the topic of DNR orders.
Can a ‘do not resuscitate’ order be reversed?
The Resuscitation Council, Royal College of Nursing, and the British Medical Association all provide guidance regarding the use of DNRs for their professionals. The use of DNRs must comply with the applicable law and local policy, a failure to do so may open the decision to challenge. A disputed DNR is unlikely to be reversed if the correct process has been followed and no clinical expert agrees it is inappropriate. If the correct process has not been applied, then it may be possible to challenge a DNR and have the decision reversed.
Do hospitals need to get permission from the patient or a family member before adding a do not resuscitate order?
The guidelines generally recommend sensitive and effective communication with patients and their families. In the vast majority of cases, discussions should be had with both the patient and their family and those views should be carefully considered. So whilst permission may not necessarily be required for a DNR, there should be clear and effective communication with the patient and/or their family.
What action can I take if I believe a loved one’s death could have been avoided had appropriate care been given?
A DNR simply means that if an individual suffers cardiorespiratory arrest, the treating team would not provide CPR. However, all other aspects of the patients’ care must be catered for in the usual way, for example administering medications, sustenance, and other general treatments. If the standard of care becomes inadequate then it may still be possible to pursue a claim for medical negligence. The DNR itself should not affect the overall care and assistance given to the patient.
What steps should I take if I, or a loved one, have been told by doctors that they would not attempt resuscitation if taken ill?
CPR, in itself, can be a very intrusive procedure, and usually, the purpose behind the DNR is to stop patients suffering unnecessarily from the negative effects of CPR. In the first instance, the patient and/or family members should talk to the treating medical team. If there has been a failure to consult then it may be possible to bring a claim under Article 8 of the European Convention on Human Rights (ECHR), the right to respect for private and family life. In previous cases, doctors were held to have breached Article 8 of the ECHR by not consulting sufficiently with the patient and family prior to the imposition of a DNR.
How can a Solicitor help if a family member feels they are not being given sufficient information about the alternative care measures in place if a do not resuscitate order has been given on the grounds that CPR is inappropriate?
DNR decisions are not just about clinical judgements, a sound decision-making process must be followed which includes consulting with the patient and/or their family. A failure on this point could lead to Human Rights breaches with particular reference to the right to respect for private and family life. It may be possible to challenge the DNR if the decision-making process is flawed or the wrong medical decision has been made.
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