BBC News published March 17, 2021: Families say disabled and elderly have been denied life-saving care during Covid pandemic.
England’s care regulator, the Care Quality Commission, is raising serious concerns about the use of Do Not Resuscitate orders during the pandemic.
Families and charities say the orders, which can deny people potentially life-saving care, have been wrongly placed on elderly and disabled people over the past year at unprecedented rates.
An interim report from the Commission last year found concerns over at least 40 orders between March and September, up from just 9 in the preceding 6 months.
Huw Edwards presents BBC News at Ten reporting by social affairs correspondent Michael Buchanan.
BBC News, UK
written by Staff
Saturday January 21, 2023
A Lanarkshire grandmother says she is living in fear after finding out doctors issued a "do not resuscitate" order without her knowledge.
The document on Marie McLean's medical file instructs medics not to attempt CPR in the event of an emergency.
The 63-year-old from Airdrie says she now cannot sleep because she is afraid of not waking up.
NHS Lanarkshire said its hospitals followed NHS Scotland guidance on do not resuscitate (DNR) orders.
The health board said any decisions should be discussed with the patient or carer by medical staff.
Mrs McLean was rushed to hospital almost two weeks ago when she was found to be unresponsive.
Her daughter Louise Gallacher told BBC Scotland: "The consultant took me into the family room and explained we have put her on a ventilator, if this doesn't work we have also put a DNR in place, so we won't be resuscitating her should she flatline.
"There were no discussions with anybody regarding the DNR."
Ms Gallacher said medics did not ask whether she agreed with the DNR or whether it was what her mother would have wanted.
"If they would have asked me, I would have said no, absolutely resuscitate her - bring her back," she said. "She has no illnesses, she is not in end of life care, not sick or poorly.
"On her medical records, it's just asthma. They said she had a chest infection or pneumonia and I wouldn't think it would warrant a DNR being put on her.
"We asked for a second opinion and did not get it. We asked to speak to the consultant when we were up in the critical care ward and we did say that we did not agree with it."
What is a 'do not resuscitate' order?
A DNR - also known as a DNACPR or a DNAR - is a form filled in by a doctor or senior nurse which instructs medial staff not to perform cardio-pulmonary resuscitation (CPR) treatment to attempt to restart the heart and breathing after they have stopped.
Other treatments will be used - but not CPR.
The decision has to be taken because CPR, which can involve chest compressions or an electric shock, often does not work and very few people make a full recovery. Near the end of life, there may be no benefit in resuscitation.
In most cases people should be informed when a DNR is in place and medics should discuss it with the patient or next of kin.
Official guidance states no doctor will refuse a patient's wish for CPR if there is a "fair chance" of success - but patients cannot demand treatment that will not work.
Ms Mclean has now been discharged from hospital but she fears becoming ill again.
"I'm not sleeping at night," she said. "I am panicking in case I don't wake up. I can't get it out of my head.
"I've been in and out the hospital with my chest, but the next time if I go in like that or not even as serious as that, they'll maybe say oh well she's got a DNR, just let her go. That's what's going through my head.
"I'm scared that because of the state of the health service, and not having beds..."
"Give me a chance. I don't want to die, I've got grandweans. I want to still live."
Ms Gallacher added: "If the doctors don't think it is beneficial and won't save her then that's fine. If my mum didn't have any quality of life we might be in agreement. But my mum wants to live.
"It is playing God with people's lives and it shouldn't be their decision."
'Shock, anxiety and fear'
Age Scotland says it has heard from people who are finding out "almost by accident" that they have DNR orders, without having a conversation about it.
Adam Stachura, its head of policy and communications, said it was creating "shock, anxiety and fear" among those affected.
"It is something there is too much secrecy about and the fact people are finding this out by accident means the process isn't working at all," he said.
He wants to see more consistency in decision-making with patients although ultimately the decision rests with the clinician.
"You can speak to your doctor but you don't have a right to say remove this," he said. "But people should have a right to find out if there is one in their name, who made the decision and when and be able to question that to better understand it."
'Compassion, care and tact'
Judith Park, director of acute services at NHS Lanarkshire, said all its hospitals followed NHS Scotland guidance.
"In terms of good practice, any decisions regarding the application of the policy should be discussed with the patient and/or carer by medical staff and this is documented in the patient record," she said.
"It is important to note that the policy guidance refers only to 'do not attempt cardiopulmonary resuscitation'. The guidance is clear that patients will continue to be managed with whatever treatments that are appropriate for their health and comfort irrespective of their DNACPR status."
The Scottish government said that its guidance was clear that healthcare professionals were expected to discuss treatment options openly and honestly with patients and families.
A spokesperson said: "It is essential that the information that CPR cannot be offered is clearly and sensitively shared with patients unless it is judged that the conversation would cause physical or psychological harm.
"Where a patient lacks capacity to engage with this conversation, relatives or others close to the patient must be informed without delay where that is practicable and appropriate.
"CPR will not always be an effective or viable treatment option for everyone, and where clinicians determine that this is the case, conversations should always be handled with the upmost compassion, care and tact.
"When a disagreement occurs, individuals can always request a second medical opinion. No one should ever feel pressured in any way when they are discussing treatment options such as CPR."
STV News November 13, 2020: Concerns over increase of 'Do Not Resuscitate' orders in hospitals.
A charity has asked for a parliamentary inquiry into the use of 'Do Not Resuscitate' orders when older people are receiving hospital treatment.
Age Scotland claim that the use of DNR orders is increasing with the procedure becoming commonplace during the pandemic.
Roseanne McKee says her family were pressured into a signing a 'Do Not Resuscitate' order when her mum was taken into hospital earlier this year.
5 News published March 18, 2021: Covid-19: Sister 'written off' by do-not-resuscitate order.
► It is a huge decision for any family to put a 'do not resuscitate' order on a loved one who is seriously ill. Well imagine if that happened without relatives even knowing.
A review of DNR orders from the start of the pandemic found that in more than 500 cases patients themselves or their relatives were not properly consulted.
The Scotsman, Scotland local
written by Elsa Maishman
Friday March 19, 2021
Age Scotland has called for an inquiry into the use of ‘Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) orders during the Covid-19 pandemic, following a damning report from the care watchdog in England.
The report by the Care Quality Commission in England found that the human rights of more than 500 patients may have been breached when Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) orders were imposed without discussion with the patient or their families.
Age Scotland has written to Healthcare Improvement Scotland calling for an investigation into the use of DNACPRs north of the border in the last year.
Liberal Democrat MSP Alex Cole-Hamilton has backed the call, saying an inquiry would reassure older people and their families that their rights are protected.
Age Scotland called on the Scottish Parliament's health and sport committee to instigate an inquiry last year after receiving calls from patients who had discovered orders in their hospital discharge notes which had been completed without their knowledge.
Brian Sloan, chief executive of Age Scotland, said: "We know from calls to our helpline that a number of older people and their families in Scotland have been very concerned and angry about the way DNACPR decisions were applied to them in the past year.
"We heard from over 60s who considered themselves to be in good health receiving an unexpected call from the GP asking them to agree not to receive medical intervention if their heart stopped beating or their breathing stopped. They were suspicious that they were targeted simply because of their age and left feeling that their lives were less valued."
He added: "We want to know exactly what happened, how many people had DNACPR decisions made without their knowledge and whether there was a criterion for people approached, such as age or shielding status.”
Mr Cole-Hamilton said: "Our health service has faced an incredibly challenging period but it's absolutely unconscionable that older people could be pushed into making major decisions like this.
"Everyone deserves kind, compassionate and informed support throughout their journey through the health service.
"An inquiry into the use of these orders would be a concrete step towards reassuring older people and their families, that their wishes will be respected, and their rights protected."
Andre Walker published December 29, 2021: Secret NHS Plot To Kill Disabled Children. Teenagers with autism and Down's syndrome were offered 'Do Not Resuscitate' orders during routine appointments with their GP during the pandemic, it has emerged. Many parents believe their child has been 'discriminated against' and say they were only asked about the order because of their learning disability. The DNR orders were reportedly offered following 'concerns about the pressure on the NHS' - but it has left families confused and 'upset'.
Daily Mail, UK
written by Kaya Terry
Monday December 27, 2021
Teenagers with autism and Down's syndrome were offered 'Do Not Resuscitate' orders during routine appointments with their GP during the pandemic, it has emerged.
Many parents believe their child has been 'discriminated against' and say they were only asked about the order because of their learning disability.
NHS England wrote to medics last year as the pandemic struck reminding them of guidance that learning disability should never be a reason for issuing a DNR.
Shocked parents are now worried their child could have agreed to the order because they may have not 'understood the question', according to an investigation by the Daily Telegraph.
The DNR orders - also known as DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) - are given to seriously ill patients and prevent doctors from performing CPR.
Guidance states they should only be put in place on an individual case-by-case basis after discussion with a patient or their family about end-of-life plans.
The Department of Health previously said it was 'unacceptable' for DNRs to be applied 'in any kind of blanket fashion'.
This comes as it was revealed that mentally ill patients and those with learning disabilities were given 'Do Not Resuscitate' orders by doctors during the pandemic.
The orders were issued if their heart stopped and at least one appears to have led to the death of a patient, it was reported in June.
Charities said they were aware of many occasions when orders were 'inappropriately' given, with one saying it saw 20 in a single month.
Jeremy Hunt, chairman of the Commons health committee, said: 'This kind of hidden prejudice must be stamped out.'
Research last year also found that do not resuscitate orders were being placed illegally on the medical files of adults with learning disabilities.
MPs responded by ordering an urgent review into the ‘appalling’ practice, calling for it to be brought to an end by Christmas.
It is feared wrongful use of the orders could be denying vulnerable people life-saving treatment during the pandemic.
Steve Scown of Dimensions UK, a learning disability charity, told the Commons health and social care committee that those his fund helped were ‘not valued as equal members of society’.
He said: ‘We’ve seen that with the number of DNARs (do not attempt resuscitation) that have been placed on people that we support without any consultation with their families or anybody who knows their best interests.
'There is a fundamental problem with how people with learning disabilities are valued within society and within the system.
‘The fact that they were just placed on files without any meaningful conversation with families or any other professional is just frankly disgraceful.’
NHS England said at the time: 'The key principle is that each person is an individual whose needs and preferences must be taken account of individually.
'Blanket policies are inappropriate whether due to medical condition, disability, or age.'
