Buckinghamshire disability group reports DNRs in place without patient knowledge
The Care Quality Commission has published a report on the use of DNRs
Buckinghamshire Disability Service (BuDS) say members of the community have reported DNR's in place without the individuals knowledge.
DNR stands for Do Not Resuscitate and is also referred to as a DNACPR. The order is placed on a patient, often in a hospital setting, where it's agreed the individual does not want any resuscitation efforts performed if their heart stops beating.
A rise in critically ill patients during the pandemic, and a focus on the treatment of them, has resulted in awareness being raised around the issue of DNR's and how they are put in place.
Andrew Clark from BuDS says members of the disability community in Buckinghamshire have discovered DNR's in place without their agreement:
"It falls into two groups so people with learning disabilities and that is usually the relative who discovers that. We know of 4 or 5 who are living happy active lives who went into the hospital with Covid and their relatives discovered a DNR in place.
"There seems to have been a blanket rule for that because they have always been wrongly given to people with a learning disability.
"The second is people with long-term illness and older people so for example. people with motor neuron disease going into hospital and finding this order that they never consented to.
"They were being applied against their wishes and to us the central issue is consent. There are always going to be circumstances where DNR's are appropriate and resuscitation can be traumatic and damaging.
"But, they should not be put in place without consent because then it becomes a value judgment about that person's life.
"We think there have always been issues with DNR's but Covid has really brought it to attention because of the amount of people in the disability community being admitted to hospital."
The CQC says while they cannot say a blanket approach was used for specific groups of people, they concluded 'there was undoubtedly confusion at the outset of the pandemic and a sense that some providers felt under pressure to ensure DNACPR decisions were in place.'
The CQC report explains:
"What we have found through our review is a worrying picture of poor involvement, poor record keeping, and a lack of oversight and scrutiny of the decisions being made.
"Without these, we cannot be assured that decisions were, and are, being made on an individual basis, and in line with the person’s wishes and human rights."
Buckinghamshire Disability Service is among several organisations calling for more to be done around misplaced DNR's and the legality of the order.
Andrew Clark from the group say the issue is extremely worrying for members of the disability community in particular:
"It has become a bitter joke amongst disabled people that we have to make sure there isn't a DNR made out for us.
"We think there are some fundamental issues like legislations setting out the status of a DNR properly in law, and there is a proper process for them to be put in place.
"But also if a DNR is given without a patient or families consent then it is a specific offence.
"This isn't about being anti-doctor, we recognise they will do all they can for people in hospital but they are dealing with death all the time and sadly more so in the last year.
"It's not about saying they are doing the wrong thing, its us saying there isn't a process to do the right thing and that needs to be laid out in law."