Older people advocates and charities have released a joint statement calling out the 'shameful and unacceptable' practice of pressuring older and vulnerable people into signing Do Not Attempt (DNA) CPR forms.

The statement* said that they were seeing shocking examples where blanket decisions seem to be being made about the care and treatment options that will be available to older and vulnerable people.

They said: “Alongside this, many of the people affected have experienced fear and anxiety, and feel that their lives and wishes do not matter. This is shameful and unacceptable.

“Difficult and painful decisions will need to be made in the weeks ahead, but these must be made on a case-by-case basis, taking account of the risks and benefits, and people’s own wishes, through honest discussions between patients, doctors and families. Whether or not to sign a DNA-CPR form is an individual’s decision, and they have a right to make that decision without feeling pressurised."

Blanket discriminatory decisions are 'unacceptable'

The statement acknowledges the significant pressures being faced by all staff working across our health and social care sectors at this difficult time, but it is said it was crucial that we continue to protect people’s fundamental human rights. It would be completely unacceptable to abandon these rights in favour of taking blanket, discriminatory decisions.

It added: “It is also crucial that governments and health services across our four nations carefully consider the ways they can provide stronger leadership and guidance – to ensure that people’s rights are upheld and communication with vulnerable people is handled in a far more sensitive way to avoid further worry and upset as we navigate the difficult path ahead of us.”

According to the  Resuscitation Council (UK), policies and documents for recording decisions about CPR have been established in many areas within the UK. The purpose of a DNA-CPR decision is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest or die suddenly.

Advance care plans and Covid-19

Last week, the Care Quality Commission wrote to adult social care providers and GP practices with a statement prepared with the British Medical Association, Care Provider Alliance and Royal College of General Practitioners. The statement sets out their shared position on the importance of advance care planning being based on the needs of the individual.

They said that the importance of having a personalised care plan in place, especially for older people, people who are frail or have other serious conditions has never been more important than it is now during the Covid 19 Pandemic.

Such advance care plans may result in the consideration and completion of a Do Not Attempt Resuscitation (DNAR) or ReSPECT form. It remains essential that these decisions are made on an individual basis. The GP continues to have a central role in the consideration, completion and signing of DNAR forms for people in community settings.

They added: "It is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need."

Much needed culture change needed about death and dying

There are now calls to urgently mainstream advance care planning in light of coronavirus. Compassion in Dying recently wrote to the Health Secretary and health bodies asking them to lead a much-needed culture change in the way society approaches death and dying, enabling them to champion and deliver truly personalised care at the end of life.

The letter said that medical professionals will have to make difficult decisions – decisions many will not be accustomed to making in such high-pressure conditions – often with scant knowledge of our patients’ wishes. And due to self-isolation and quarantine measures, our patients may not even have their loved ones at their side to advocate for them.

It added: "These decisions will be made much easier for us, and more importantly for our patients and their families, if we have a clear sense of their priorities, concerns and preferences for care and treatment well before they find themselves in a crowded intensive care unit.

"The process by which people’s end-of-life wishes are sought, discussed and recorded is known as ‘advance care planning’, a practice that is part of our daily routine. It must now become part of all health and care professionals’ vocabulary and toolkit during this pandemic and beyond."

 

 

*The statement was signed by Heléna Herklots, Older People’s Commissioner for Wales, Caroline Abrahams, Charity Director Age UK, Deborah Alsina, Chief Executive Independent Age, Jane Ashcroft, Chief Executive Anchor Hanover
Victoria Lloyd, Chief Executive Age Cymru, Eddie Lynch, Commissioner for Older People in Northern Ireland, Donald Macaskill, Chief Executive Care , ScotlandLinda Robinson, Chief Executive Age Northern Ireland and 
Brian Sloan, Chief Executive Age Scotland.