Doctors and other medical staffs can no longer put a “Do Not Attempt Cardio-Pulmonary Resuscitation” (DNACPR) or commonly known as “Do Not Resuscitate” (DNR) notice on patient’s medical notes unless there is proper consultation with the patient, family members and relatives, or have convincing reasons not to do so, the UK Court of Appeal rules on June 16.
The ruling came after doctors at the Addenbrooke’s Hospital in Cambridge were found to have unlawfully placed such DNR notice on a patient named Janet Tracey, a care home manager from Ware, Hertfordshire who died from a serious car accident and sustained broken neck three years ago. Before the accident, she was already diagnosed with terminal lung cancer.
The court document [pdf] reveals Tracey “was engaged with issues of care during her stay in hospital, she would ask what was going on, being quite medically minded from her work she wanted to know about the drugs, the equipment and what the nurses were doing.” She expressed her wish to be involved on decision-making when it comes to her care. She would whisper or write notes, despite having little ability to talk and move.
One doctor was said to have mentioned possibly “tough decisions,” but she was quoted writing these statements: “I will do my damdest. Please do not exclude me.”
Two DNR notices were placed on Tracey’s medical case. The first one was withdrawn after five days when her family, particularly her daughter Alison, discovered and challenged the decision to do so. When her health deteriorated, a second one was made but with approval by the family two days prior to her demise on March 7, 2011.
Following her death, husband David sought a court case against Cambridge University Hospitals NHS Foundation Trust, which is responsible for said hospital, and Secretary of State for Health to review the first DNR notice imposed on her wife and to get clarity over such notices and consent. The Equality and Human Rights Commission supported David’s case.
Sitting with Lord Justices Ryder and Longmore, Master of the Rolls Lord Dyson announced that Addenbrooke’s "violated Mrs Tracey's Article 8 right (under the European Convention of Human Rights) to respect for private life in failing to involve her in the process which first led to the notice.” This was in response to the argument of the defendant that failure to have consultation with Tracey or her family was not a breach of article 8 of European convention of human rights.
Tracey’s husband, meanwhile, was very happy with the decision ruling the first DNR notice was unlawful.
"It feels as though the wrong done to Janet has been recognised by the Court and the fact that her death has led to greater clarity in the law gives us all some small comfort,” David says.
The UK court, however, rejected a separate challenge to push State Health Secretary Jeremy Hunt to come up with national guidelines regarding DNR notices to hospitals in an attempt to clarify confusion and rules.
The Cambridge University Hospitals NHS Foundation Trust says it is "considering the implications of this judgment and the next steps very carefully.”
The Resuscitation Council, the Royal College of Nursing and the British Medical Association released the current guidance on DNR notices. Other reports say the guidance is expected to undergo an update in accordance with the latest court ruling.
