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Doctors Have Legal Duty Over DNR Orders

June 17, 2014

Doctors have a legal duty to consult with and inform patients if they want to place a Do Not Resuscitate (DNR) order on medical notes, says the Court of Appeal in England.

The issue was raised by a landmark judgement that found doctors at Addenbrooke’s Hospital, in Cambridge, had acted unlawfully.

Janet Tracey, who had terminal lung cancer, died there three years ago.

Her family say she and they were not consulted when a DNR notice was placed.

Guidelines for doctors already recommend that patients and families are involved in such decisions, but the court ruling now makes it a legal requirement.

In the judgment, the Master of the Rolls, Lord Dyson, said: “A Do Not Attempt Cardiac Pulmonary Resuscitation decision is one which will potentially deprive the patient of life-saving treatment, there should be a presumption in favour of patient involvement.

“There need to be convincing reasons not to involve the patient.”

He went on to warn that “doctors should be wary of being too ready to exclude patients from the process on the grounds that their involvement is likely to distress them”.


Mrs Tracey, from Ware, in Hertfordshire, was suffering from advanced lung cancer when she was taken to hospital after a serious car crash.

Her husband and daughters were distressed when a “do not resuscitate” notice was put on her hospital records.

It was cancelled after the family complained, though a second was later put in place – after talks with the family and two days before Mrs Tracey died at the age of 63.

Since her death, Janet’s husband, David, has fought for a full judicial review to seek clarity over DNR notices and consent.

Speaking after the judgment David Tracey said: “We’re all so pleased that the Court has agreed that imposing a do not resuscitate order on Janet without consulting with her was unlawful.

“It feels as though the wrong done to Janet has been recognised by the Court and the fact that her death has led to greater clarity in the law gives us all some small comfort.”

Lawyers Leigh Day, on behalf of the Tracey family, said: “The Judgment sends a clear message to all NHS Trusts, regulatory bodies and healthcare professionals that patients have a legal right to be informed and consulted in relation to decisions to withhold resuscitation.

“The belief such information would cause distress is no longer a sufficient reason not to inform and consult with a patient. There must now be convincing reasons to displace this right.”

The ruling does not give patients the right to have CPR, but it does mean they should be consulted.

Dr Keith McNeil, the head of Cambridge University Hospitals NHS Foundation Trust in charge of Addenbrooke’s said: “Today’s ruling hinges on a specific point of law. There was no criticism of our clinical care.

“It is a fact of life that every day people die in hospitals. From my own experience as a specialist hospital doctor, the most important thing is that these patients are treated with the utmost respect and dignity.

“End of life situations involve doctors and nurses having emotionally challenging but necessary conversations, with patients and their families about what happens in the final stages of their care. Medical staff use a combination of their compassion, experience and judgement at these difficult times, to try and find the right pathway for each individual patient, and provide the support needed for everybody involved.”

3 Comments leave one →
  1. June 17, 2014 2:27 pm

    Reblogged this on sdbast.

  2. June 17, 2014 10:27 pm

    DNR is not the only issue here.

    What DNR actually means is the Liverpool Care Pathway, which is starving the patient to death even if non-dying as permitted by case law since 1999.

    Just because the Court of Appeal rules that the patient and next of kin must be consulted on DNR, it does not mean you give the God awful death of starvation and thirst that can takes weeks and up to a month or more.

    Far better for those deemed terminally ill to be looked after in a hospice or at home (if carers are available) to ensure no Liverpool Care Pathway, which the government suggests not to be used but as yet no law has been passed (?) to forbid.

    Better to die at home as at least can have a cup of tea and a sandwich because as you state:
    The ruling does not give patients the right to have CPR, but it does mean they should be consulted.
    So you die at any rate whilst medical professionals do absolutely nothing, even if you, the patient, fight to live.

    This is what was described as Institutionalised Homicide (a posh word for murder).

    You will find hospital policy on DNR means you have no right to treatment and treatment includes food.

    This despite:
    Article 11(1) of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises the right of everyone to adequate food. The UK has signed and ratified, and in so doing is legally bound by the ICESCR, in particular, the human right to adequate food.

    Human rights are between state and individual and the NHS is the state to people.

    Hospital patients are not the only ones being left to starve by the state, but millions of people in the community every day. See my blog on how all could be fed every day.

  3. Derek permalink
    December 13, 2015 4:36 am

    I think hospital killed my mother because no dnr

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