Reader letter - Care home use of Do Not Resuscitate (DNR) orders to be investigated

We in Equalities and Human Rights welcome the Care Quality Commission’s recently announced investigation into concerns which we and others were obliged to lodge with Government during the March lockdown period and onwards regarding the use of do-not-attempt-resuscitate (DNAR) orders being deployed and applied wrongfully in blanket fashion in care homes at the start of the pandemic.

Tuesday, 13th October 2020, 5:18 pm
Image: Joe Giddens, PA Wire/PA Images

Such a practice is a violation of Human Rights.

Now that we as a nation have moved into the second wave of the pandemic with numbers of Covid-19 cases exceeding the numbers in March 2020, the Care Quality Commission (CQC) are to investigate also ours and others’ ongoing concerns that some care homes still have blanket orders in place covering groups of residents.

Blanket DNRs are a practice which are now being widely condemned by the CQC and medical bodies.

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Decisions should be made on a case by case basis.

The sick person as an individual or family members should be consulted about whether or not to attempt resuscitation if the sick person becomes dangerously ill. It should be that only in the most extreme of circumstances should doctors make a DNAR decision on the spot, outside of these requirements.

During the first wave of the pandemic it was being reported that blanket applications of Do Not Attempt Resuscitate orders were being applied against certain groups and individuals, unbeknown to them or their families.

Disability equality, age equality groups and others continue to highlight a need for there also to be a focus on how DNARs were being used outside of care homes also, with an emphasis upon investigating DNAR applications on the basis of a person’s protected equality characteristics in non-care home settings too.

In May 2020, NHS England were obliged to issue a statement instructing that disabled and vulnerable patients must not be denied personalised care during the pandemic

NHS England said the aim was to ‘maintain and champion personalised approaches to care and treatment’, adding: “The current pandemic has brought into sharp focus the need for everyone, regardless of background or circumstance, to have the opportunity for their needs, wishes and preferences to be considered.

"The outbreak of coronavirus does not change long-established best practice that decisions around care and access to treatment, including end of life care, are made on an individual basis and with clinicians, following the principles of personalised care.”

They issued a warning at that time that blanket Do Not Attempt Resuscitate should not be happening.

Nor should they happen in this second wave either.

Chrissy

Equalities and Human Rights