Scandal: 500 care home patients given DNR orders without consent
Image: Shutterstock / Halfpoint
Hundreds of care home residents had Do Not Resuscitate orders imposed on them without their consent during the pandemic, a damning report reveals today. The care watchdog investigated the ‘blanket use’ of the notices in social care amid the crisis and highlighted 508 cases which may have breached human rights law.
The Care Quality Commission report said overall around 30 per cent of people with a DNR in place – and 28 per cent of relatives – were not aware it had been applied.
Some patients have reported finding notices slipped into their bags after leaving hospital. The notices – also known as DNARs and DNACPRs – stop doctors attempting cardiopulmonary resuscitation (CPR) to restart a patient’s heart.
Guidance states they should only be put in place on an individual case-by-case basis after discussion with a patient or their family about end-of-life plans.
But the CQC report said: ‘We heard concerns that decisions were being made without involving people or their families and were being applied to groups of people rather than taking into account each person’s individual circumstances.’
It said this potentially breached Article 2 of the European Convention on Human Rights, which protects the right to life.
The report said: ‘Applying “blanket” DNACPR decisions to groups of people in particular equality groups, such as people with a learning disability or older people, whether or not a DNACPR form has been completed, is potentially discriminatory and unlawful.’
The CQC surveyed 2,048 adult social care providers for the report.
It found that five per cent of DNR notices – 508 in total – were put in place without agreeing it first with the individual or their family.
Wrongful use of the orders could deny vulnerable people life-saving treatment and the CQC said it could have prevented some going to hospital.
The report warned: ‘In the early days of the pandemic, we heard that ambulance staff had been reluctant, or had refused, to take people to hospital.’
It stressed: ‘These figures also raise serious concerns that individuals’ human rights were potentially being breached.’
It concluded: ‘Covid-19 has shone a light on end-of-life planning, treatment and care. Too many people have been left feeling ignored and unable to have their voice heard and their wishes respected.’
Charities said the ‘disturbing‘ report showed that older people’s right to life was ‘ridden roughshod over during the pandemic‘.
Families previously warned of the misuse of DNRs on people with learning disabilities over the past year.
The report said in future healthcare orders must not be used in a ‘discriminatory way‘ for ‘people with a learning disability who are not near the end of their lives‘.
The Daily Mail has previously highlighted the plight of thousands of patients being handed DNR notices without their consent, with some finding them popped secretly in their bag by nurses before they are discharged from hospital.
Yesterday the charity Compassion in Dying said the pandemic had highlighted a lack of clarity and communication surrounding DNRs.
One man who found one in a bag after returning from hospital said: ‘This had not been discussed with me or my family at any time during my stay. My wife was so shocked that she vomited on the carpet and could not stop crying.’
Caroline Abrahams, of Age UK, said: ‘It’s extremely disturbing that this report effectively stands up the notion that some older people’s rights to choose were ridden roughshod over during the pandemic.’
Gavin Terry, of the Alzheimer’s Society, added: ‘This should never have happened as it effectively denied individuals their right to life without appropriate discussion’.
Dan Scorer, of learning disability charity Mencap, said: ‘It is unacceptable that assumptions are made about people’s quality of life or their wishes in relation to treatment. They deserve and have a right to so much better. Everyone should receive access to personalised and non-discriminatory support. We now need to see action from Government.’
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tom0mason
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Please note that DNR is not always the terminology used in the NHS but is now a separate form called DNACPR and stands for do not attempt cardiopulmonary resuscitation. DNACPR is sometimes called DNAR (do not attempt resuscitation), or DNR (do not resuscitate) but they all refer to the same thing. For a more complete explanation of what and how they are to be used see https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/
and
https://network.healthwatch.co.uk/network-news/2020-04-09/nhs-policy-use-%E2%80%98do-not-attempt-to-resuscitate-forms%E2%80%99 which has some coverage of these forms in the COVID cases.
IMO from the scandalous days of the Liverpool Care Pathway for the Dying Patient (LCP) (see https://en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the_Dying_Patient ) where the trend was set for the NHS not to just ameliorate suffering of the sick but to actively ensure their prompt death, has remained. From a caring profession to an economically driven system of killing!
The NHS appears to have become evermore arbitrary about using the ‘Do Not Attempt to Resuscitate Forms’. Those perceived to be at death’s door or any other reason the doctor/consultant/clinician may perceives as justifiable seems to allow the issuing of these forms — and as reported here –too often without the patient’s knowledge or consent.
The NHS administrative officials and bureaucrats who maintain and drive this system appear to have become more sensitized to Government requirements to save money than the medical professional’s requirement to “First, do no harm” (the teaching to medical students and medical professionals is outlined here https://www.gmc-uk.org/-/media/documents/First_do_no_harm_patient_safety_in_undergrad_education_FINAL.pdf_62483215.pdf [a 368.7 KiB download pdf] ). I note that as far as I can find out NHS administrators and bureaucrats do not undergo this type of training.
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