But it’s the Wonder of the World!

Doctors must involve patients in life-or-death resuscitation decisions unless doing so would actively cause them harm, three senior judges have made clear, in a landmark ruling over a terminally ill woman placed on a so-called “DNR” notice.

The Court of Appeal found 62-year-old Janet Tracey’s human rights were violated when doctors at Addenbrooke’s Hospital, Cambridge, placed the order in her medical notes without properly consulting her.


You do have
to wonder what else is going on if they’re not even bothering to ask people whether they’d like to die or not.

As many as 80 per cent of those who die in hospital do so with instructions to doctors in place not to attempt resuscitation, he said.

A fairly widespread problem then.

11 comments on “But it’s the Wonder of the World!

  1. Read the judgement. This wasn’t a routine case, it was a patient recently diagnosed with terminal cancer who broke her neck in a road traffic accident. It was found that the doctor did talk to the patient’s daughter about the DNACPR notice, but did not explain the implications with sufficient clarity.

    I don’t believe that there’s a doctor in the world who would want CPR attempted on them in these circumstances. And I doubt that CPR would ever have been attempted in this case, notice or no notice. The ruling was on the legal question of whether the notice was permissible without informed consent from the patient or her family.

  2. The ruling was on the legal question of whether the notice was permissible without informed consent from the patient or her family.

    Well, quite. What are you defending, exactly?

  3. I’m not defending anything, I’m attacking Tim W’s misrepresentation of the facts. This wasn’t a usual situation, and it was perfectly clear that the patient didn’t want to die. But unfortunately, neither she nor the doctors had any choice about it. The healthcare funding model has got nothing to do with it.

  4. > As many as 80 per cent of those who die in hospital do so with instructions to doctors in place not to attempt resuscitation, he said.

    A fairly widespread problem then.

    Presuming, of course, a majority of that 80% (or their relatives) who die in hospital with DNR’s weren’t consulted about it to begin with.

    The article isn’t clear, but this seems to be an attempt to subtly change the criteria to make things worse than they seem.

    For example a cursory reading of the article implies:

    * DNRs are being put in place without input from the patient or their families
    * 80% of patients who die in hospital have DNR’s attached to their files
    * Therefore 80% of patients aren’t being consulted about DNR’s

    I’d be very much surprised if this was the case and what’s more likely happening is:

    * 80% of patients who die in hospital have DNR’s attached to their files, and only a (certain) proportion of these aren’t being consulted prior to them being placed.

    That (certain) proportion is what’s missing from the article and is suspiciously so in order to (IMHO) sell the story.

  5. @PJH
    It’s not misrepresentation because the policy makes it a binary situation. There is or isn’t a DNR in place. If a DNR can be in place without assent, it doesn’t make any difference the proportion of DNRs assented. Any particular DNR can be non-assented. Like you can’t be some percentage dead.

  6. @bloke, I was under the impression that the problem (here) was:

    “DNR’s are being used without consent of either the patient, or their families if they cannot give consent.”

    Not

    “DNR’s are being used.”

    That’s certainly what the article seems to be banging on about. The family mentioned accepted a second DNR being placed – they’re simply bringing judicial proceedings about the first (non-consensual) DNR.

    So not a binary situation:
    1) DNR not in place because it’s not considered necessary
    2) DNR not in place because (relatives of) patient refused it
    3) DNR in place because of consent
    4) DNR in place, but consent not sought.

    You seem to be lumping 1+2 and 3+4 together and calling it a day. The article seems to be bringing #4 into the spotlight, but appear to be lumping #3 into the figures when it shouldn’t to make a headline.

  7. @PJH
    If non-assented DNRs exist it’s binary. There’s only two possible states.
    1) You know there’s a DNR because you’ve assented
    2)You don’t know.

    Your 1-4 are irrelevant.


  8. You do have to wonder what else is going on if they’re not even bothering to ask people whether they’d like to die or not.

    The question in this instance is not whether or not you’d like to die or not, it’s whether you’d like your last breath peacefully lying against the pillow or flat on the bed with a junior doctor breaking your ribs. Terminal cancer plus CPR or DNACPR = death. Same outcome.

  9. I’m attacking Tim W’s misrepresentation of the facts.

    This is known as begging the question.

    The healthcare funding model has got nothing to do with it.

    Which might be why TW never mentioned it?

  10. Sorry, I was wrong when I wrote that the issue was one of whether informed consent was legally required for a DNACPR notice. I’ve now read the whole judgement:

    The fact that the clinician considers that CPR will not work means that the patient cannot require him to provide it. It does not, however, mean that the patient is not entitled to know that the clinical decision has been taken.

    The finding was that, despite her reluctance to discuss her prognosis, the doctors should have informed the patient that the DNACPR decision had been taken, not that she should have been able to overrule it. The court allowed that there are circumstances in which it would be proper for doctors to judge that a patient should not be informed, but judged that this particular case was not covered by them.

    All this is a million miles away from Tim W’s “they’re not even bothering to ask people whether they’d like to die or not.”

  11. As Dr. C says, CPR crunches ribs. Very few survive it & those that do are wrecked. Lay people don’t know this, so we have an education problem.

    Also one of timing: it’s too late to have a sensible conversation when you or a loved one is ill enough to need CPR right now. We need to have that when making our wills or, at latest, when getting the lousy lab results/after the first minor stroke or heart attack.

    After the LCP, I wouldn’t trust the NHS to proceduralise this – maybe a departing Royal or celeb might set an example?

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