The rise in ‘do not resuscitate’ cases a grave concern
Why are frail elderly, chronically ill and care homes residents being pushed into DNR?, asks Helen Mcardle
THE iconic campaigner for Indian independence, Mahatma Gandhi, famously said that the “true measure of any society can be found in how it treats its most vulnerable members”.
The balance between compassion and pragmatism has and will be tested like never before by the coronavirus pandemic.
Heroism, hard work and selfsacrifice by clinicians, social care staff and NHS workers, as well as the enthusiasm of community volunteers, can give us some consolation of light in the darkness.
But in recent weeks there has emerged a disturbing trend that is difficult to describe as anything other than an attempt to exclude some of those least likely to survive the outbreak from treatment – effectively to discard them as second-class members of society.
This is the issue of elderly people and those with life-limiting conditions being pressured, en masse, into signing Do Not Resuscitate forms.
One particularly alarming example emerged in Wales when a GP surgery distributed letters to patients telling them they were “unlikely to be offered hospital admission and certainly will not be offered a ventilator bed” if they fell ill with Covid-19. These were patients who had conditions such as incurable cancer, motor neurone disease, untreatable heart and lung conditions such as pulmonary fibrosis, or severe heart failure.
It went on to say that these patients would be better off cared for at home and stated that “we would therefore like to complete a DNACPR (Do Not Attempt Cardio-pulmonary Resuscitation) for you” so that “in the event of a sudden deterioration in your condition because of Covid-19 or disease progression the emergency services will not be called and resuscitation attempts to restart your heart or breathing will not be attempted”.
It is difficult to see how that could feel like anything other than: “you are a burden the NHS cannot accommodate right now”.
Despite the insistence of First Minister Nicola Sturgeon and erstwhile Chief Medical Officer Dr Catherine Calderwood that there has been no change in guidance, numerous cases are cropping up in Scotland too – as they are repeatedly across the UK.
Last week there were reports that the family of an 86-year-old woman with memory problems and a lung condition had been sent a DNR form after a telephone call with a locum GP.
A 73-year-old from Glenrothes, Alison Sibbald, revealed that she had been shocked to be sent home following treatment at the Victoria Hospital in Kirkcaldy with a letter stating that she should not be given CPR on account of her health problems. She has COPD and a heart condition.
“It’s like they are giving up on older people,” she said.
In the past week The Herald has also been contacted by the family of a woman with a brain injury who requires round-the-clock care in one west of Scotland care home.
They did not want publicity for their case, but were shocked to be told by their GP practice that she was being placed on a DNR due to a “lack of oxygen supplies”.
A number of residents in the same facility, registered at different GP practices, were also placed on DNRS out of the blue in the same week.
The Herald has also heard from the daughter of a 84-year-old man on a dementia ward in Fife concerned that elderly patients were being “mopped up” to clear beds after he was suddenly placed on a DNR on March 20, without her knowledge or consent despite having power of attorney. He had been in hospital since January and was “not acutely unwell”, she said.
There are also stories of hospitals refusing to admit sick care home residents.
There is nothing fundamentally wrong with DNR – people who are frail or sick must have the right to pass away with dignity. But it should be a choice.
It is also true that in a crisis rationing of care can be unavoidable. But if Scotland has so much extra capacity now that the new NHS Louisa Jordan may not even be needed, then where is the justification for pre-emptively removing the right of the most vulnerable to care?
Donald Macaskill, chief executive of Scottish Care, told The Herald that despite denials, blanket roll outs of DNR are “definitely happening” north of the Border.
“We’ve seen evidence – both anecdotal and hard evidence – that some GPS have sent out letters encouraging people to sign DNACPR.
“Now, in normal circumstances it’s actually really useful for families and the persons themselves to think about what they would want in terms of treatment and care. That’s good anticipatory care planning.
“But what we are witnessing – and at the moment it seems to be in a few cases – is pressure being placed on either the individual or family, or care homes, to get everybody there to sign up to DNACPR.
“That is wholly unacceptable. It is a decision for the individual. There should not be a blanket assumption. That’s blatant discrimination.”
If Scotland has so much extra capacity ... where is the justification for preemptively removing the right of the most vulnerable to care?