Do-not-resuscitate orders: are your wishes clear enough?
In a recent review by England’s Care Quality Commission (CQC), it was found that do-not-resuscitate orders (DNARs or DNACPRs) were wrongly allocated to groups of care home residents during the coronavirus pandemic, causing potentially avoidable deaths.
There is now concern that this ‘blanket’ approach is still in place across our care homes, and CQC are calling on care providers to remember to check with the person and/or their attorneys (under a Lasting Power of Attorney) or Court of Protection deputies.
What prompted this report on DNARs?
The CQC received 40 submissions from loved ones of those affected, mostly about how do-not-resuscitate orders had been allocated without the person or their family’s consent.
What is a do-not-resuscitate order (DNAR)?
A do-not-resuscitate order is an instruction for healthcare professionals not to attempt CPR should a person’s heart stop beating.
Who can decide on a do-not-resuscitate order?
If you have a long-term health condition or a terminal illness, someone from your healthcare team, such as a doctor or consultant, should discuss with you about what you can expect and what your treatment options are. At this point, they will assess whether CPR would be successful or not, should the situation arise. If they feel CPR would be unsuccessful, they will issue a DNAR form, unless you have specified otherwise in your Lasting Power of Attorney for Health and Welfare.
If you do not have mental capacity, the doctor or nurse will discuss this with your family. Your loved ones cannot refuse life-sustaining treatment on your behalf unless you have granted them this power in a Lasting Power of Attorney, or if you have an appointed welfare deputy under the Court of Protection who can make the decision on your behalf.
How can I ensure my end-of-life wishes are fulfilled?
Beyond writing a Will, which can outline who can manage your finances and assets, and what you’d like to happen once you’re gone, you should consider writing a Lasting Power of Attorney (LPA).
Lasting Powers of Attorney
An LPA allows you to give a relative or loved one (an ‘attorney’) the power to make decisions on your behalf, should you lose mental capacity.
There are two types of LPA: a health and welfare, and property and financial affairs. A specialist solicitor can help you make and register an LPA, and will ensure that your wishes are clearly specified and that the document is legally sound.
Advance decision or a living Will
You could also consider making an ‘advance decision’. An advance decision allows you to express your wishes to refuse medical treatment in future. It is sometimes referred to as a living Will. A specialist Wills solicitor can help you to make one of these.
The findings of this report are no doubt concerning, both for the families involved, and for those who are in care homes currently. The report has, however, prompted a wider investigation, which is due to be reported on in early 2021.
In the meantime, as with any other life planning matter, preparation is key in saving you and your loved ones from any uncertainty and extra stress.