New DNAR guidance promised after poor practice during the pandemic

New national guidance on Do Not Attempt Resuscitation (DNAR) orders are to be published by NHS England after concerns were raised by campaigners about poor and unlawful practice during the coronavirus pandemic.

In May this year, Kate Masters was supported by Compassion in Dying and law firm Leigh Day when she threatened legal action against Matt Hancock over the lack of clear, accessible national guidance on DNAR orders.

This was after Compassion in Dying received hundreds of calls relating to cases were DNARs were communicated to patients insensitively or unclearly, and blanket decisions not to resuscitate were issued by some health and care providers.

The charity said that between 2017 and 2019, approximately 7% of all queries to its free, nurse-led information line related to these decisions. Concerns ranged from patients who want to refuse CPR feeling ignored and abandoned by healthcare professionals, to people distressed when DNAR decisions were not properly discussed with them or their loved ones, to health and care professionals confused by the lack of clarity around DNAR.

It said that the Covid-19 pandemic had highlighted and exacerbated ongoing problems concerning accurate and accessible national guidance regarding CPR, which contributed to a proliferation of poor and unlawful practice in recent months.

Clear guidance needed to provide lawful and compassionate care

Kate Masters brought a legal challenge against the government for failing to use its emergency powers to ensure patients and their families understand how decisions are made about DNACPR orders in light of the current coronavirus pandemic. Her late father brought a successful judicial review in 2014, which established that a DNACPR notice issued to his late wife Janet Tracey without her or her family’s knowledge was a violation of her human rights.

Davina Hehir, Director of Policy and Legal Strategy at Compassion in Dying, said: “We know that many patients who express a wish to protect themselves from potentially harmful or futile CPR are not supported to do so, and equal distress is caused when a DNAR decision is not thoroughly and sensitively explained to a patient and their family. Both scenarios completely undermine person-centred care at the end of life, and risk jeopardising sensible efforts to demystify CPR decisions and improve communication between doctors, patients and families around end-of-life decisions.

“We urge NHS England and Improvement to ensure this new guidance is written with patients and families so that it is truly fit-for-purpose. It must help patients and families understand what DNAR means, how decisions are made and that they have a right to be involved in discussions about these decisions.

“It must also include clear guidance for healthcare professionals on proper protocol and how to have sensitive, honest conversations with patients and families, so that they can provide lawful and compassionate care. Having supported 56,000 people to plan ahead for the end of life, Compassion in Dying is ready to offer our wealth of expertise in this area.”