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32,000 patients a year let down by their medical teams

How would you feel if this happened to you?

“Do Not Resuscitate” – Could this Happen to You Without your Consent?

The NHS knows that it's happening - and why it's happening - but won't be doing anything about it anytime soon. Here's how to protect yourself and your family.

An estimated 32,000 patients a year are being subjected to "Do Not Resuscitate" orders without their consent. This astonishing finding has emerged as a result of a recent audit carried out by the Royal College of Physicians.

The organization reviewed the end of life care of a sample of 9000 patients subjected to a "DNR" order. In 16% of cases, there was no record of any conversation having taken place with the patient before the order was imposed. And in 20% of cases, the patient's family were excluded from the decision-making process. 

Every year, a decision is made not to resuscitate some 200,000 patients. This audit suggests that the decision is made without consulting 32,000 of those patients. This can, to a degree, be explained by the fact that many patients have already lost consciousness by the time this decision is made. However, the chilling fact that 40,000 families are presented with this decision as a fait accompli is difficult to understand.

The audit’s chairman Professor Sam Ahamedzai recognizes that this is unacceptable:

“When a decision has been taken, it is unforgivable not to have a conversation with the patient – if they are conscious and able – or with the family.”

Professor Ahamedzai urges doctors to be more open with dying patients. Half of the patients his audit considered actually died within just one day after being identified as nearing their life’s end.

“This is being done very late in the day.” he says, “As doctors, we just don’t like to face up to it.”

There is some limited acceptance within the NHS that this is an issue:

“Although this audit presents a snapshot of end-of-life care within NHS hospitals,”, says and NHS spokesperson, “there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made.”

Why is this happening?

What this audit shows, is that doctors are humans too. Like the rest of us, they are deeply uncomfortable addressing issues surrounding the end of life. Just because it’s understandable, though, doesn’t make it acceptable. People are being failed at the end of their lives, as are their families.

Condemning the situation as unacceptable and waiting passively for a political solution is one approach, but it’s not a very empowering one. Much better if we take control of our own lives and destinies, even at the end.

How would you feel if this happened to you?

If medics made a “do not resuscitate” decision about you without consulting you or your family, would you mind?

If your answer to that question is a resounding “Yes I would mind!”, let’s think about likelihood. We are all aware that our lives will come to an end one day. Who knows when that will happen. If we’re lucky, the end will come peacefully in our sleep after a long and healthy life. But if we’re one of the 200,000 people who reach the end of our lives in hospital the subject of a DNR order, this audit shows there’s roughly a 1 in 5 chance of this decision being imposed upon us without any input from us or our families.

So, if you really would mind if this happened to you and your family, and you don’t feel comfortable with the odds of it happening, you may feel that it would be a good idea to take action protect yourself, particularly if doing so were relatively easy and cost-effective to do so.

Protecting yourself

The simplest and most cost-effective way of protecting yourself is to make an Advance Directive or Living Will. This is a document in which you state clearly what you will and won’t consent to if ever you can’t speak up for or think for yourself.  This includes what you do and don’t consent to in terms of end of life care.

As long as you can think and speak for yourself, your Advance Directive doesn't come into play, because you will be able to accept or refuse treatment for yourself as you see fit. But if you cannot think or speak for yourself, your Advance Directive will be legally binding. So, it’s a powerful shield that keeps your deepest personal preferences firmly on the agenda. The key is to let your family know that you have made an Advance Directive, and tell them where you have stored it, so they can use it on your behalf if the time comes.

Empowering your Family

Strictly, families, partners and loved ones don’t automatically have the power to give or withhold consent to treatment on your behalf. So, doctors can perfectly legally say that the people closest to you have no right to be consulted in how you are cared for. However, you can override this principle with a Lasting Power of Attorney for Health and Welfare.

By making and registering a Health and Welfare LPA, you can appoint the people closest to you to be your advocates and protectors if you ever lose the ability to think and speak up for yourself. To take legal effect, it has to be registered on a central database run by the Office of the Public Guardian. But once it’s registered, it’s there as a safety net for the rest of your life.

If you have registered a Lasting Power of Attorney for Health and Welfare, the doctors providing your end of life care have to consult your attorneys and respect their views at every stage if you’re no longer able to make decisions for yourself.

When you make a Lasting Power of Attorney for Health and Welfare, you are asked to make an important choice: whether or not to give your Attorneys decision-making power over “life- sustaining treatment”. This is a crucial choice that goes to the heart of what happens when a DNR decision is made.

If you decide against making an Advance Directive, you may prefer to give your Attorneys the power to make decisions about life-sustaining treatment, that so you have someone to speak up for you when this critical decision is addressed. However, if you are uncomfortable with putting such an onerous burden on those closest to you, it is best to make your own views about life-sustaining treatment explicitly clear in your Advance Directive.

Taking action, while you’re fit and well, to protect yourself and empower your family is the best overall strategy for ensuring that you never become one of the 32,000 people let down each year.

For help in putting the right measures in place, just get in touch, either via our contact form, or by giving us a call on 0151 601 5399.

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