Our Director and Head of Inquest Law, Gareth Naylor, has received instructions to act on behalf of two separate families in relation to inquests where there are issues regarding end-of-life care.
These new instructions have some striking resemblances to a recent case reported on by the BBC:
Pandemic care home death – Family to sue over mother’s end-of-life consent.
DNACPR
DNACPR stands for ‘Do not attempt cardiopulmonary resuscitation (CPR)’. It means that if a person has a cardiac arrest or dies suddenly, there will be guidance on what action should or shouldn’t be taken by a healthcare professional, including not performing CPR on the person. There are many reasons why a person might have a recorded DNACPR decision. Some people choose to have one simply because they do not want to be resuscitated in an emergency. They might have a personal reason to make this decision, but this varies depending on the individual. Others make the decision along with their health care provider, after experiencing health issues that might inform their decision.
There are also occasions when healthcare teams may have to make decisions on behalf of patients. In this case, they would try to involve patients or their loved ones wherever possible. This might happen because a patient is so unwell from an underlying illness, that CPR will not prevent their death. By making the decision on behalf of the patient, there is an opportunity for the patient to have a peaceful, dignified death.
DNACPR only specifies whether a person will receive CPR or not. Patients will still receive appropriate treatment for their health issues and all personal care needs will be attended to.
Other ways of making recommendations. For people who also want to create a personalised plan for other types of care and treatment, there are some other processes in place. These include:
ReSPECT
The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. It is currently available in many areas of the country. These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment. What is important to a person and clinical recommendations are recorded on a non-legally binding form which can be reviewed and adapted if circumstances change.
Advance Decision to Refuse Treatment (ADRT)
An ADRT enables someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may not be able to do so. It is a legally binding document that allows the individual to express their wishes while they are able to make decisions and communicate them in advance of a possible emergency.
[Resusitation Council UK 2023]
We have seen on too many occasions, confusion arising between medical practitioners as to how a ReSPECT form should be completed and what it means. Medical care must always be provided for reversible medical conditions and to protect the dignity and suffering of a patient, irrespective of whether they’re at end of life stage.
We will provide further updates as and when these cases unfold.
