A Report published by the Care Quality Commission has raised some crucial concerns regarding ‘Do Not Resuscitate’ orders (DNR’s) during the Covid Pandemic.
The Report has revealed that decisions were made, and DNR’s were signed, without the involvement of patients and/or their relatives. It has also suggested that DNR’s are being applied in a blanket way to particular groups of society – such as those with dementia or learning difficulties.
Before approaching the subject further, it is crucial to explain that the signing of a DNR means that CPR will not be carried out on the patient if they suffer cardiac arrest. Best practice is therefore to have proper discussions with the patient involved and their families. However, this Report has shown that some GP’s for example have been signing DNR’s for care home residents without any prior conversation taking place.
These findings are unnerving due to the fact that the signing of a DNR is essentially a life-or-death decision. Even though CPR is only effective in around 10% of cases, and GP’s are basing their decisions on the likely success rate for the patient, should doctors be ‘playing God’ in this manner? Ultimately, this decision should be placed in the hands of the individual involved.
The CQC’s Report has highlighted that unprecedented pressure caused by the pandemic has led to situations where DNR’s were incorrectly conflated. In order to improve the process in the future, the CQC has recommended that a ministerial oversight group be created to work with health and care providers, and local governments, to make improvements.
Hopefully, this will include the creation of proper, consistent processes around timely conversations about people’s care.