Fury at ‘do not resuscitate’ notices given to Covid patients with learning disabilities

Exactly right growstuff

The issue here is people with severe learning disabilities. The allegation is that a value was put on their lives and decisions made that their lives weren't worth saving, regardless of expected outcome.

My mother, aged 93, had a DNR on her notes during her recent hospital stay. The doctors did discuss it with her, but she refused to accept it, saying she wanted to be resuscitated in the event of her collapse. I discussed this with my daughter who is a doctor. She explained to me in extremely graphic detail what happens during resuscitation. It is not pleasant. Marydoll and Septimia have already mentioned this up thread, but I think many people just do not understand the violent nature of resuscitation. My daughter told me if resuscitation is successful, the patient would then need to go into ITU and despite that patient being successfully resuscitated, the final outcome is absolutely not assured. Very old patients have about a 3% to 5% chance of being resuscitated successfully and in common with all other patients regardless of age, are likely to be left with other physical injuries, caused by the resuscitation. A young and otherwise healthy adult will stand a good chance of eventual recovery, but people my of my mother’s age, or those with other co morbidities do not do well at all.

My mother’s doctor in the hospital signed her DNR because he/she was legally entitled to do so, regardless of any objections from my mother or her family. Obviously, the medics try to discuss rationally with the patient and their family, but my mother is stubborn and refused to yield. I felt that resuscitation on such an old lady would be both pointless and cruel, and I told my mother that this was my opinion.

I get a little fed up with the emotive language used around DNRs. Medics do not practice euthanasia, they decide, often in a team and discussion with family, whether or not DNR is suitable in the event of the patient’s death. Resuscitation is not suitable for everyone. It is not only violent, but is more often unsuccessful than it is successful.

Sodapop I looked at their methodology and intentions for this, I have to admit it did look pretty vague and wishy washy.

Don't hold your breath NellG the CQC do very little and seem to be conspicuous by their absence at times of crisis.

There's shockingly little information available on this, however the CQC are due to issue their findings by March this year.

It seems there was a significant increase in DNR forms being signed by Drs last year, and the sudden increase triggered the concerns. Something like 12 a year leaping to 13 in April 2020 alone in just one organisation.

I'll be interested to see what the CQC have to say when they finally publish their findings.

There have been occasions reported recently when DNR notices were put on the files of older people without the consent of the patient or their families.
I worked with adults with learning disabilities for many years and I know first hand that often they were not afforded the same treatment or care as more able people. I have fought many a battle with doctors and Consultants who did not place much value on the life of a less able person. Not all of course, there were also some very kind and enlightened medical staff.

I know of at least two cases, one in my own family, where a DNR notice was put on their notes without consultation with family. The NHS is wonderful but through a few family members having had hospital stays I know that they are not infallible and these things do happen when staff are under pressure. This is not meant as a criticism but as a comment based on knowledge.

Mencap has spoken out about them and the Care Quality Commission said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.

I don't think either is into conspiracy-to-kill theories.

Sorry, before such circumstances arise!

I was advised that a DNAR would not be suitable for me in the event of catching Covid, due to my multiple health problems and for the very reasons that Septimia has stated. (It it can be intrusive, distressing and unsuccessful.)

It isn't a pleasant conversation to have with family, but it should be done before such circumstances arrive.
I'm sure that many reading this may not realise what an awful procedure it is and the lasting effect on the patient if they do survive.

It shouldn't be applied automatically, without prior consultation.

I agree that consultation with family should be required if at all possible. In the current circumstances it may be that it is not always feasible, although that doesn't make it right.

A DNAR was placed on my FiL but there was a good reason. The doctors said that resuscitation would not work anyway due to his other health problems.

I think that none of us like the idea of our loved ones not getting help in a critical situation where resuscitation might be considered. However, there are some people who cannot accept that it can be intrusive, distressing and unsuccessful.

Having said that, the automatic application of DNARs is not acceptable if there are family members who could/should be consulted.

Perhaps "usually" isn't definite enough and it should be obligatory.

Elegran the point made in the OP is that the rules/guidance aren’t always properly followed. There’s absolutely evidence of this so clearly better safeguards are needed.

A decision of such importance should be made after detailed discussions with family and medics.

Do Not Resuscitate notes are added to patients' notes after consultation between doctors, family, carers and the patients themselves, and after consideration of their medical needs. They are not issued unilaterally by some faceless authority with no knowledge of the individual. Another conspiracy-to-kill theory.

Thin end of the wedge. No telling what this could lead to in the future.

More culling.