Yesterday the Court of Appeal ruled that doctors acted unlawfully in the case of Janet Tracey, by placing a ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) order on her records without consulting her or her family. This is a landmark ruling, codifying the need for healthcare professionals to ensure patients are at the heart of decisions made about their treatment at the end of life.
Mrs Tracey was made subject to two DNACPR notices while she was a patient at Addenbrookes Hospital. The Court found that the hospital breached Mrs Tracey’s rights under Article 8 of the European Convention of Human Rights because there was a failure to consult her and her family properly or notify her of the decision to impose the notice.
The family also argued that the Government had unlawfully failed to publish clear national guidance on DNACPR notices, but this element of the case was not won.
The ruling recognises the importance of communication and the involvement of patients in clinical decision-making about end-of-life issues. It also recognised that these conversations can be distressing and difficult for doctors to initiate, but however difficult they are, they are crucial to ensuring the patient has what they consider to be a good death.
In some situations patients are not able to make decisions about their care and treatment at that critical moment because they either lack the capacity to make the decision, or they lack the physical ability to communicate their wishes. In these instances it is very helpful if the patient has made their wishes known in advance in an Advance Decision to Refuse Treatment, or via a Lasting Power of Attorney so that the doctors have access to clear information about the patient’s wishes to inform their decision-making.
Advance Decisions are free to make, and can be a good way to introduce the conversation with healthcare professionals about end of life wishes. These conversations are best undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as a patient’s circumstances change.
Most people who contact Compassion in Dying’s end-of-life information line do so for support or tools to make their end-of-life decisions known in advance via an Advance Decision to Refuse Treatment, and many wish to refuse CPR. This is evidenced in opinion polls showing that the vast majority of people would choose comfort care only at end of life.
It is Compassion in Dying’s hope that going forward, more people will make Advance Decisions and appoint Lasting Powers of Attorney, and that doctors will take their responsibility to discuss a patients options seriously and ensure patients are at the center of decisions made about their care and treatment. With a recent report on care of the dying finding that healthcare professionals had recognised 87% of dying patients were in their last days of life, but that they had only told 46% of patients who were capable of discussing this, there is clearly a long way to go. Yesterday’s judgment can only work to improve communication between patients approaching the end of life, their doctors and families.