Govt to issue new DNR guidance after threat of judicial review

The Government is set to release new guidance on ‘Do Not Resuscitate’ (DNR) forms, following accusations of mixed messaging for care homes during the coronavirus outbreak.

Kate Masters, who was involved in a successful judicial review of the DNR decision making process in 2014, had threatened the Government over its failure to provide consistent guidance during the COVID-19 pandemic.

The Court of Appeal established there is a legal duty for hospitals to consult with and inform patients if they are placing a DNR on their records, ruling that a hospital had breached Masters’ mother’s human rights by placing a DNR on her records without telling her.

Blanket DNRs

Masters wrote a legal letter informing the Government of her intention to launch a judicial review claiming Health Secretary Matt Hancock had failed to issue clear guidance nationally or to explicitly protect patients’ rights.

Hancock initially handed responsibility for resuscitation policies to local health bodies, which Masters said has led to concerns about ‘blanket DNRs’, which would apply to a whole subset of people over certain ages, or with certain conditions.

She said COVID-19 patients were at risk of having DNRs imposed on them without consultation or being informed how they could object, and called on Hancock to produce guidance which clearly states to NHS trusts that blanket DNRs are unlawful.

‘Confused and distressed’

Lawyers representing Masters said: “It is fundamentally important that at such a crucial stage in the care of people who may be approaching the end of their life, that people know and understand how the DNR process works, and what authority the medical profession may have, outside of a patient’s and family’s wishes.

“Since the start of the pandemic, we have been inundated with requests for help from confused and distressed patients and families about do not resuscitate decisions.

“Many appear to have had their right to respect for private life infringed, just as Kate’s mother had, with evidence of DNRs being implemented without consultation, without families being told, and without any clear explanation of the process for making these decisions.”

They added: “Trusts and staff are under unprecedented burdens with the day-to-day management of healthcare provision, giving rise to a real risk of local inconsistency and arbitrariness as to decision-making procedures in the absence of clear national policy.”

‘Completely unacceptable’

Masters said that the Health Secretary has now informed her legal team that he will be producing and publishing two documents on the NHS website, one for doctors, and the other for patients and relatives.

A Government spokesman said the forthcoming guidance was already in the process of being drawn up and was not in response to the legal threat.

He said: “We have made clear that it is completely unacceptable for DNR orders to be applied in a blanket fashion to any group of people.

“The Government has taken consistent action on a number of fronts to prevent this from happening and NHS England is currently creating patient-facing guidelines on how to challenge a DNR and access support.”

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