Do not resuscitate advice
how, if at all,
you want to manage
the media"
Richard Follis, Partner
Most such disagreements can be resolved through discussion. Where deadlock remains, the court can be asked to decide.
Patients with mental capacity to understand the options open to them can decide whether they want to refuse particular treatment. This is usually done at the time the treatment becomes needed. It is also possible to express personal wishes in advance through a living Will or advance directive.
However, where the patient is too young to understand and weigh up the options or lacks mental capacity, decisions come down to what is in the patient's best interests.
Again, problems can arise if a family disagrees with doctors' assessment of what is in the best interests of a particular patient. Once more, if discussions fail to resolve the dilemma, the court can be asked to decide.
CPR, or cardio pulmonary resuscitation, can be life saving, but also traumatic. If not administered, a chance to save a life may be lost. On the other hand, few would want to undergo CPR in the final stage of life shortly to come to an end due to, say, terminal cancer. If the effect of the CPR would be to delay the inevitable by a few minutes, some might prefer not to prolong dying.
Doctors considering whether CPR would benefit a particular patient as part of the medical management plan are required to take the patient's wishes into account. More particularly, they must obey the wishes of a competent patient who decides s/he does not want to be resuscitated.
Where the patient lacks mental capacity to decide for themselves, then the doctor should consult with family, and which in turn can receive do not resuscitate advice. A decision not to carry out CPR should always be documented, with the reasons for making it and the names of those with whom it was discussed.
This note, in the patient's records, is sometimes known as a DNAR - Do Not Attempt Resuscitation Order. It is not really an order, it is a medical opinion reached in advance. It should be reviewed regularly to see whether it remains appropriate to the patient's condition - which of course may change.
It is important that all relevant information is available to the doctor who has to decide whether resuscitation, if needed, should be attempted. Ensuring the patient's wishes and condition are fully understood is key.
Where these are not understood, or where there is disagreement about whether:
- the patient has capacity
- the treatment is futile
- more of a burden than a benefit
legal advice can empower the patient and family to understand the legal principles by which these requirements are assessed.
Usually, further discussions with the medical team, or a well written note to senior hospital management and based on a clear understanding of the legal framework will help resolve deadlock. If not, then ultimately the court can be asked to intervene.
Access Legal from Shoosmiths' team of specialists has many years' experience of relaying do not resuscitate advice to patients and their families.
Where necessary we can also deal with making an application to the court or responding to a hospital's application for a declaration as to the legality or lawfulness of a particular course.
