31 January 2018

Do Not Resuscitate

By Miranda Marshall, Director, Hayes + Storr.

We are introducing a little credit-card-sized card for our clients who make a Lasting Power of Attorney for Health and Welfare (“LPA-H+W”) or an Advance Decision (also known as a “Living Will”). In the same way as a kidney donor card, this can be carried at all times to alert medics to the existence of the LPA-H+W. When found, it can be acted upon quickly, especially in an emergency.  Also, it is a good idea to register your LPA-H+W with your GP and medical Consultant. These two steps should ensure that you are not resuscitated if you do not wish to be.

Increasingly, care plans of care home residents and hospital patients note any decision on their resuscitation; however, a recent report found that up to 40,000 patients a year across England were having Do Not Resuscitate (“DNR”) orders imposed on them without their families being made aware.

A DNR order refers to a decision by medics not to attempt cardiopulmonary resuscitation (“CPR”) if a patient’s heart stops beating or they stop breathing. It does not cover other treatment decisions.

CPR in real life is not the same as on a television drama and is often a massively physical process which, as well as possibly being futile, can result in broken ribs, bruising and pain and much reduced quality of life. Yet many families see it as something that should be done to save their loved one. For many, not performing CPR means giving up and accepting death.

Factors affecting a patient’s decision on the withholding of life-sustaining treatment include the acceptance of the inevitable progression of disease, trust of doctors, the feeling of being a burden to others, symptoms and the preference to die naturally.

A medical clinician has the responsibility for deciding whether a particular treatment is or is not necessary and appropriate for the patient; this includes the pros and cons of CPR. There is a presumption of patient involvement and that of their family wherever possible.

It is not lawful for a medic to treat a patient who has capacity and refuses treatment. Nor is it lawful to treat a patient who lacks mental capacity if he has made a valid Advance Decision to refuse it. Neither, is it lawful to treat a patient if he has made a LPA-H+W (with the relevant powers given) and the attorney (acting in their best interests and as their proxy) refuses such treatment. If a clinician treats a patient against such a decision, and if that decision is known about by the clinician, it is a criminal offence.

Sensitive consultation with and support of families about DNR prevents trauma and distrust of the medical system, thereby enabling the patient to have a ‘good death’.

This article aims to supply general information, but it is not intended to constitute advice. Every effort is made to ensure that the law referred to is correct at the date of publication and to avoid any statement which may mislead. However no duty of care is assumed to any person and no liability is accepted for any omission or inaccuracy. Always seek our specific advice.

If you would like further advice on this matter please contact Miranda on 01328 710210. If you require advice on any other legal matter call 01328 863231 or email law@hayes-storr.com.