A patients’ rights group is demanding the Department of Health in England draw up national rules on the use of “do not resuscitate” orders following the Guardian’s revelation that the husband of a woman who died in Addenbrooke’s hospital, Cambridge, is suing the hospital and health secretary Andrew Lansley.
Patient Concern wants legally enforceable regulations to ensure the orders are added to patients’ medical notes only with their consent or, if they are not mentally competent, the permission of their family or lawyer. Guidance would not be enough.
Janet Tracey, 63, who had terminal lung cancer, broke her neck in a car accident in February and died the following month. Her husband, David Tracey, alleges the hospital deprived his wife and himself of their human rights. He claims doctors twice put do not resuscitate orders in his wife’s medical notes, cancelling the first after she objected to it, then putting in a second order three days later without her consent or any discussion with her. He is also trying to force the government to follow Scotland’s policy of having national guidance.
Both the hospital and the health department deny acting unlawfully, while Addenbrooke’s insists its clinicians acted in accordance with its own policy and the health department says existing professional guidance is more appropriate than national regulations set by the government. Lansley’s advisers have said he will not comment on the issue.
The General Medical Council (GMC), which regulates doctors, and the British Medical Association both insisted medical staff have the final say on how the orders are used.
However, Roger Goss, co-director of Patient Concern, said that though doctors argue that cardio-pulmonary resuscitation (CPR) offers patients a poor chance of survival, refusing it when patients want it “reduces it to zero”. He added: “The medical profession opposes this approach because it transfers power from the medic to the patient.”
The BMA said only 15-20% of patients who receive resuscitation ever go home and, on ethical grounds, doctors should not attempt treatments where patients would not benefit. Each case should be taken on its own merits, they said.
The position of doctors was also inconsistent, Goss said. “They think it is legitimate to put in ‘do not resuscitate’ notices, maybe with patient’s consent, but the medical profession almost universally opposes the idea that patients should be given any assistance to die. You cannot have it both ways.”
He also claimed doctors “had no problem ‘selling’ procedures to patients with similarly low chances of success and/or terrible risks, providing it is an interesting case”. Goss also warned that with the NHS in England expected to make savings of £20bn over the next four years, do not resuscitate orders “could become surreptitious standard practice for everyone over a specified age.”
Patient Concern was an interested party in the case which the GMC says settled the law on who should make the decision on whether or not patients are treated. In 2005 Leslie Burke, who had a degenerative brain condition, brought a case before the courts claiming the right to artificial nutrition and hydration, come what may, which gave him rather than doctors the ultimate say in treatment. The GMC, which opposed him, won the case on appeal.
The GMC said the ruling meant doctors had no legal or ethical obligation to agree to a patient’s request if they considered treatment was not in the patient’s best interests.
