The implications of inappropriate ‘Do Not Attempt Resuscitation’ orders
Until it happens to you, it can be difficult to comprehend the full extent of the far-reaching implications associated with a tragedy.
Working within the Wills & Probate sector, I’d heard from a few clients that they felt ‘Do Not Attempt Resuscitation’ orders (“DNARs”) were being inappropriately placed on loved ones’ files while they stayed in care homes or hospitals. This was extremely concerning because the family indicated this would not have been the wishes of the person receiving care.
My dear, ‘adopted grandmother’, fondly known to all as “Grinny” had this happen to her whilst she stayed in hospital following a fall. The kicker? She hadn’t been conscious to discuss such a document – even if she had changed her mind and wanted one in place. Thankfully, the keen eye of a family member spotted this and confirmed that Grinny would never have consented to a DNAR order, and it swiftly disappeared…
I began talking more to my clients about this issue and found an overwhelming majority had similar experiences. There were instances, like Grinny, where the person concerned was unconscious, varying in extremity to cases where older or vulnerable people were pressured by medical staff into signing a DNAR, feeling they had no other choice. In rare cases, family members felt DNAR orders were used as an excuse to remove routine treatments or therapies that led to a swift decline in the mental and physical health of their loved ones.
Surely, we can’t let this continue - something must be done.
A key theme in my discussions with clients is a lack of understanding regarding the scope of a DNAR order both by themselves and their medical practitioners. Simply put, “resuscitation” relates to cardiopulmonary resuscitation – treatment given when someone stops breathing or their heart stops beating. This can involve:
1. Chest compressions
2. Electric shocks to stimulate your heart
3. Equipment designed to oxygenate your body
4. Giving medicine (designed to re-start your heart or breathing) by injection
It does not include ongoing treatment for the management of long terms conditions, pain relief nor artificial nutrition or hydration, as some of my clients had been led to believe.
In certain cases, a medical professional may impose a DNAR order, even if the person to whom it relates does not agree. However, this decision should be discussed with the person it impacts and reasons for such a decision given. It must be made on an individual basis and based on unique health and circumstances. It should not apply simply because the person it relates to is older, or lives in a care home, has a learning disability, autism or dementia. If you disagree with a DNAR order imposed on you or a loved one, you are entitled to a second opinion.
If a person lacks mental capacity to discuss a DNAR order that medical professionals may wish to impose, the medical professionals should first check if an Advanced Directive or Lasting Power of Attorney is in place. If they don’t have either of these in place, the Doctor should speak with loved ones to gain further information on their wishes and preferences. If they do not have any appropriate friends and family, the doctor should ask an independent mental capacity advocate to represent the person impacted in the decision-making process.
SFE aims to work with care homes and hospitals to raise awareness and understanding of DNAR orders to prevent further misuse in the future. If you have been impacted by inappropriate DNAR orders, please do get in touch with SFE if you would like to share your experiences and help us work to improve the current practices in place. Please email [email protected]