Do Not Resuscitate – is it really your choice?
What are your legal rights if you are asked to sign a DNR (Do Not Resuscitate) form?
Over the last few years, it has become standard practice in some GP surgeries to ask elderly patients to sign Do Not Resuscitate forms. During the Covid-19 epidemic the practice has become far more widespread.
Many people have reported feeling pressurised into signing Do Not Resuscitate forms. Some people have said they have signed the DNR form because they thought they had no choice. This is an important human rights issue and deserves wider attention.
What is a Do Not Resuscitate form?
If you sign a Do Not Resuscitate form ( also known as DNACPR – Do Not Apply CPR) you are giving consent for medical treatment to be withheld if your heart stops or you can no longer breathe without a ventilator. In other words, you are agreeing that a hospital, care home or GP can decide not to attempt to save your life at that point.
Abuse of Do Not Resuscitate notices and human rights
There has been controversy about Do Not Resuscitate notices for several years. In 2014 the Court of Appeal was asked to consider whether a hospital had breached a patient’s human rights by placing a DNR on her medical notes without first obtaining consent. The decision of the Court of Appeal was that the patient’s right to respect for private and family life under Article 8 of the Human Rights Act 1998 had been breached.
It’s not only in cases where the patient hasn’t given consent to the DNR where there could be a breach of their human rights. It could also be a violation of their rights if the patient felt pressurised into giving their consent.
How should doctors deal with Do Not Resuscitate notices?
The legal rights protected by Article 8 of the Human Rights Act are not absolute. This means that an individual’s rights under the Act can be restricted. Every case has to be assessed on its own particular facts. There is a legal principle that is very well established in English law which is that a doctor can’t be forced to give a patient a particular treatment. If there are very good reasons for a doctor to refuse to give a patient a particular treatment, it’s lawful for the doctor to refuse.
You might be thinking what is the point of asking a patient to sign a Do Not Resuscitate form if a doctor can refuse treatment anyway? The point is that following the Court of Appeal case in 2014 doctors have an obligation to involve the patient and/or the patient’s family in the decision-making process. Unfortunately, there are still far too many reports of DNR notices being placed on patients’ records without any evidence of consultation.
We all know that it can be very difficult to talk to someone about their end of life care. It’s even more difficult where the person has a condition such as dementia or a learning disability. But just casually asking an elderly or disabled person to sign a DNR form when they call into their GP’s surgery is not involving the patient in the decision-making process properly. It could be a breach of their human rights.
Don’t be rushed into end of life decisions
The whole issue of end of life care needs careful consideration and a patient should not be rushed into making an on the spot decision. Nor should a patient be made to feel they have no real choice about signing the form. If this happens to you and you feel unsure about signing the form, say you want more time to consider the implications.
DNR Guidance for health professionals
Health professionals have guidance from their professional bodies and from organisations like Resuscitation Council UK to assist them in resuscitation practice and training. Nevertheless concerns remain about the way DNRs are used. There has been particular concern about the use of DNRs in relation to people with learning disabilities. The Confidential Inquiry into premature deaths in people with learning disabilities (CIPOLD 2013) identified issues such as premature decision-making and ‘blanket policies’ as being endemic but little seems to have changed; we are still seeing current reports about such issues.
An alternative solution
Here are some key points to consider:
- end of life care should be discussed well in advance of any serious health situation arising;
- these are legal not just medical issues;
- relatives and friends can only protect you if you give them the legal authority to make decisions and enquiries for you;
- talking about specific scenarios helps, even if it feels uncomfortable;
- be prepared to protect your human rights.
The role of Lasting Powers of Attorney for Health and Welfare
One of the most important actions you can take to protect your legal rights is to make a Lasting Power of Attorney for Health and Welfare. This type of power of attorney can be very powerful in preventing your wishes from being ignored. In it, you are able to give your attorneys legal authority to give or refuse consent to medical treatment (including end of life care) on your behalf.
There are also sections of the LPA Health and Welfare where you can insert your wishes about how and where you want to receive care and medical treatment. Make use of those sections. Mention your views about issues like Do Not Resuscitate notices. You can also give further details of your wishes in a separate Letter of Wishes addressed to your attorneys to guide them. This will also provide valuable evidence of your wishes that can be presented to medical and social care professionals.
The information in this article is for general interest. It does not constitute legal advice and the author accepts no responsibility for any action taken as a result of reading the contents You should always get independent legal advice before taking any action relating to the issues referred to in this article.
Please note that copyright in all the material in this Blog is held solely by the author, and this material may only be accessed for personal study, and may not be reproduced or republished in any form without the author’s prior written permission.