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New advice on 'do not attempt resuscitation' orders follows concerns over 'blanket' use in pandemic

FILE PHOTO: Nurses care for a patient in an Intensive Care ward treating victims of the coronavirus disease (COVID-19) in Frimley Park Hospital in Surrey, Britain, May 22, 2020. Picture taken May 22, 2020. Steve Parsons/Pool via REUTERS/File Photo - Steve Parsons/REUTERS
FILE PHOTO: Nurses care for a patient in an Intensive Care ward treating victims of the coronavirus disease (COVID-19) in Frimley Park Hospital in Surrey, Britain, May 22, 2020. Picture taken May 22, 2020. Steve Parsons/Pool via REUTERS/File Photo - Steve Parsons/REUTERS
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The Government is to issue new guidelines on the use of "do not attempt resuscitation" (DNAR) orders following criticism that they have been applied in a "blanket" manner during the coronavirus pandemic.

The "patient-facing" document will set out, in clear language, how patients and their families can participate in decision-making and what to do if they disagree with doctors.

It follows a threat by campaigners to take the Government to court over an alleged failure to provide consistent advice on DNARs amid the virus outbreak.

The early weeks of the pandemic were dogged by reports of bad practice regarding the orders, with concerns raised by care organisations that elderly people and others were being pressured into signing DNAR forms.

Article eight of the European Convention on Human Rights requires that DNAR decisions, also known as "do not attempt cardiopulmonary resuscitation", or DNACPR, are taken in consultation with a patient or their family, that patients know in advance how decisions will be made, and what to do in a disagreement.

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The new legal action was threatened by Kate Masters, whose late father David Tracey brought a successful judicial review in 2014 which established that a DNAR notice issued to his late wife Janet without her or her family's knowledge was a violation of her human rights.

Ms Masters said she was concerned that DNARs were being imposed in "seemingly blanket ways" without consultation with patients or their families.

She had signalled her intention to apply for permission for judicial review of Health Secretary Matt Hancock's failure to issue clear national guidance or a directive to ensure that patients' Article eight rights in relation to DNARs are protected.

In her legal letter to Mr Hancock, Ms Masters provided examples of DNARs being made without consultation and said concerns about their wrongful use were a result of him delegating resuscitation policies to a local level during the pandemic.

The Government has now said it will publish two documents to ensure patients and families understand how DNAR decisions are made in light of the pandemic.

One document will be for patients and their families, setting out matters such as the right to be involved in the decision and how to request a review, while the other is for NHS staff. Both will be published on the NHS website.

Davina Hehir, the director of policy and legal strategy at Compassion in Dying, which supported the move, said: "This is a victory for common sense.

"Coronavirus has highlighted and exacerbated ongoing problems concerning accurate and accessible national guidance regarding CPR, the lack of which has contributed to a proliferation of poor and unlawful practice during the pandemic.

"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 DNACPR 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."

A Department of Health and Social Care spokeswoman said: "We have made clear that it is completely unacceptable for DNACPR 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 DNACPR and access support.

"This work was already under way and is not a result of legal action."