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Lawyer calls for consistency on DNR orders

The current Court of Protection case Re L is further evidence that the NHS should have a uniform policy on do not resuscitate (DNR) orders, a legal expert has claimed.

22 August 2012

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An NHS-wide policy would protect patients and clinicians by introducing clarity and consistency into the circumstances under which the orders should be put in place, said Merry Varney, a human rights lawyer at Leigh Day & Co.

Re L concerns a 55-year-old Muslim man (L) who is severely brain damaged and in a persistent vegetative state. His condition means he lacks the capacity to make decisions about his medical treatment.

Days after L suffered a cardiac arrest, Pennine Acute Hospitals NHS Trust, which is responsible for his care, placed a DNR notice in his notes without consulting his family. When L’s family objected, the DNR notice was removed.

“Yet again this is an instance of a loved one being given a DNR order without first telling the family,” said Varney. “One wonders whether the trust would have told the patient had his condition been different and he had been conscious. Time after time we have seen DNR orders being put on people’s records without either the family or the patient being aware,” she said.

“It is clear that across the NHS there needs to be clear guidance as to when and how these orders are placed on people’s records. They are a measure to prevent potentially life-saving treatment and therefore the position as to when they can be used, the information to be given to patients and families in advance, and the process if there is a disagreement needs to be absolutely clear,” Varney continued.

L’s family is fighting for him to receive life-saving treatment, if his condition deteriorates, as they believe that “life is sacred and it would be contrary to the tenets of their religion not to provide life supporting treatment”.

Pennine Acute Hospitals NHS Trust is seeking a court declaration that it would not be in his best interests to offer him ventilation or resuscitation if there was “a life-threatening event”.

Claire Watson, appearing for the trust, said it was the unanimous view of clinicians treating L, as well as independent experts, that L has “minimal prospects of improving any neurological function and no meaningful prospect of further recovery”.

The trust argues that treatment should now be limited to what doctors consider is reasonable to maintain his dignity and to relieve any pain and discomfort he may be feeling - but it would not be in his best interests for active resuscitation or ventilation to be provided in the event of another cardiac arrest or other deterioration of his condition.

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Vulnerable Clients