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Thu, 9 July 2020

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Compassion in Dying backs DNACPR legal challenge to Health Secretary

Compassion in Dying

4 min read

End-of-life charity has received hundreds of calls relating to CPR and DNACPR

Compassion in Dying today announces its support for Kate Masters’ legal challenge to the Secretary of State for Health and Social Care, Matt Hancock, over the lack of national guidance on Do Not Attempt Cardiopulmonary Resuscitation decisions during the coronavirus pandemic.

The case has been brought in the wake of recent media reports of poor and unlawful practice regarding Do Not Attempt Cardiopulmonary Resuscitation orders (DNACPRs), including DNACPRs being communicated to patients insensitively or unclearly, and blanket decisions not to resuscitate being issued by some health and care providers.

Compassion in Dying, a national charity that has supported over 56,000 to prepare for the end of life, is backing Ms Masters’ case and has written to the Health Secretary to share its insights and call for clear, national guidance on DNACPR decisions.

Between 2017 and 2019, approximately 7% of all queries to Compassion in Dying’s free, nurse-led information line related to CPR and DNACPR.

A common concern is from patients who want to refuse CPR but who feel ignored and abandoned when attempting to discuss this with healthcare professionals, often leaving them worried that they could be resuscitated against their wishes in future.

One anonymous caller reported: “I am 87 and asked my GP for a DNAR form. They said it wasn’t a necessary choice to make at this stage of my life. I am very worried.”

Another told the charity: “I said I would not want to be resuscitated during an angiogram I had coming up and was then refused the procedure with no explanation or discussion.”

Calls to the charity’s information line have also demonstrated the distress caused to people when DNACPR decisions are not properly discussed with them or their loved ones in accordance with the law, as highlighted in Kate Masters’ case.

An anonymous caller reported: “My mum is in a care home and the GP placed a DNAR on her records. No one spoke with me and I don’t know what it means.”

Compassion in Dying also receives calls from health and care professionals confused by the lack of clarity around DNACPR; how it interacts with other advance care planning tools including living wills (also called Advance Decisions or Directives, which allow someone to refuse life-prolonging treatment) and Lasting Power of Attorney for Health and Welfare (which enable an appointed person to make health and care decisions on someone’s behalf if they become unable to); and the systems for recording this information.

A common query is whether DNACPR orders ‘travel’ with an individual between care settings, which can result in disjointed care for patients and risks their wishes not being known or followed.

Davina Hehir, Director of Policy and Legal Strategy at Compassion in Dying, said:

“The coronavirus pandemic has highlighted and exacerbated ongoing problems concerning the lack of accurate and accessible national guidance regarding CPR, which must now be addressed as a matter of urgency.

“Many patients want to be protected from CPR because they understand it will have a slim chance of success for them, and they do not want to risk being left with a poor quality of life if they do survive. Some have witnessed loved ones endure pain and distress during and after CPR, and quite understandably they want to avoid the same. The failure to acknowledge a patient’s wish to refuse CPR is just as unacceptable as failing to thoroughly and sensitively explain a DNACPR decision to a patient and their family. Both scenarios completely undermine person-centred care at the end of life, and risk jeopardising sensible, well-meaning efforts to demystify CPR decisions and improve communication between doctors, patients and families around end-of-life decisions.

“Improving the availability of accurate and accessible national guidance regarding CPR is a simple yet important mechanism that would help patients and families understand what DNACPR means, how decisions are made and that they have a right to be involved in discussions about these decisions. It would also help health and care professionals who are working under huge pressure at the moment to provide lawful and compassionate care. We call on the Health Secretary to show leadership on this crucial issue and use his emergency powers to ensure patients’ rights are protected and provide clear, accessible information on DNACPRs.”


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