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Fri, 4 December 2020

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Compassion in Dying welcomes Court of Appeal decision on Tracey, confirming that competent patients must be consulted on decisions about their end of life care

Compassion in Dying | Compassion in Dying

3 min read Partner content

“Today’s judgment from the Court of Appeal states that the duty to consult patients should involve a discussion about the patient’s wishes and feelings, and that this is best undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as a patient’s circumstances change.”

The Court of Appeal has today ruled that doctors acted unlawfully in the case of Janet Tracey, by placing a ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) order on her records without consulting her or her family.

At the heart of Dignity in Dying and Compassion in Dying’s work is patient choice, and we welcome patients’ views being heard and respected in relation to decisions on end-of-life care and treatment.

Sarah Wootton, Chief Executive of Dignity in Dying and Compassion in Dying, said:

“This ruling recognises the importance of communication and the involvement of patients in clinical decision-making about end-of-life issues.  Communication is paramount, and doctors must raise these issues with competent patients and their families where appropriate, even if these conversations are distressing and difficult for doctors to introduce.

“Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) orders are sometimes considered in the best interests of patients facing the end of their lives who lack capacity or who may not be able to give their views due to the nature of their illness.  In these instances it is very helpful if the patient has made their wishes known in advance in an Advance Decision to Refuse Treatment, or via a Lasting Power of Attorney so that the doctors have access to clear information about the patient's wishes to inform their decision-making.

“Today’s judgment from the Court of Appeal states that the duty to consult patients should involve a discussion about the patient’s wishes and feelings, and that this is best undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as a patient’s circumstances change.

“Most people who contact Compassion in Dying’s end-of-life information line do so for support or tools to make their end-of-life decisions known in advance via an Advance Decision to Refuse Treatment, and the majority wish to refuse CPR.  This is evidenced in opinion polls showing that the vast majority of people would choose comfort care only at end of life.”

“Given that the imposition of a DNACPR notice is something that will happen to many people, and that at the time it is discussed, the patient may not be able to give his or her views due to illness and incapacity, it is even more important that those wishes are set out in advance in an Advance Decision, or the patient appoints an LPA, so that the doctors have access to clear information about the patient's actual or likely wishes to inform their decision-making.”

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