DNAR orders

Mae'r ymateb i'r cais hwn yn hwyr iawn. Yn ôl y gyfraith, ym mhob amgylchiad, dylai fod wedi ymateb erbyn hyn. (manylion). Gallwch gwyno drwy yn gofyn am adolygiad mewnol.

Dear Department of Health,

What is the fail safe that the department uses to ensure that any citizen that is places on a DNAR is not put onto it unlawfully by a Doctor Death?

Yours faithfully,

Joe Jordan

Department of Health and Social Care,

 

Our ref: DE-1114863

 

Dear Mr Jordan,
 
Thank you for your correspondence of 14 January about Do Not Attempt
Resuscitation Orders.

 

Cardio-pulmonary resuscitation (CPR) is a form of treatment that tries to
restart someone’s heart and breathing.  Under normal circumstances, if
someone’s heart and breathing stops unexpectedly, for example, if they
have a serious injury or heart attack, the healthcare team will try CPR if
it might help.

 

If a patient is towards the end of life and cardiac or respiratory arrest
is an expected part of the dying process, CPR will not always be
clinically appropriate.  In some circumstances, therefore, a Do Not
Attempt Cardio-Pulmonary Resuscitation (DNACPR) order will help to ensure
that the patient dies in a dignified and peaceful manner and, possibly, in
their preferred place of care.

 

Clinical judgement is a crucial part of DNACPR decisions.  Such decisions
must be clinically appropriate for the individual involved, weighing up
the possible benefits of DNACPR for that patient against any burdens or
risks associated with the treatment.  The Resuscitation Council (UK) has
provided detailed guidance on techniques and specialisms; for example,
resuscitation for newborns or by dentists.  The British Medical
Association, the Royal College of Nursing and the Resuscitation Council
(UK) have produced a joint statement setting out a framework within which
local policies on CPR attempts may be formulated.  It is for NHS trusts to
satisfy themselves that they have appropriate arrangements in place and
that those arrangements are suitable for the purposes of clinical
governance.

 

There is also expert guidance available to assist those making complex
decisions in discussion with other members of the healthcare team, the
patient and their family, such as that issued by the General Medical
Council (GMC) in 2010 (Treatment and care towards the end of life: good
practice in decision making).  The guidance is clear that, as with other
treatments, decisions about whether CPR should be attempted must be based
on the circumstances and wishes of the individual patient, and that this
may involve discussions with the patient, or those close to them, or both,
as well as the members of the healthcare team. 

 

Where CPR might be successful but it is judged that restarting the heart
and breathing would not offer overall benefit to the patient, the doctor
should explain sensitively to the patient the risks and burdens associated
with giving CPR, as well as the length of survival and level of recovery
they might reasonably expect.  The treating doctor should try to reach
agreement with the patient (or those close to the patient) about whether
CPR should be given or withheld.  If the benefits, risks and burdens are
evenly balanced, GMC guidance says that the doctor should normally act in
accordance with the wishes of the patient, or those close to the patient.
 

 

If, after discussion the doctor remains of the view that CPR would not be
clinically appropriate, they are not obliged to attempt it.  In those
circumstances, they should explain their reasons to the patient (or those
close to the patient) and any other options that may be available,
including seeking a second opinion.  They should also record in the
patient’s notes the reasons for their decision. 

 

As with all decisions they make, the doctor must be prepared to justify
their decision in a particular case if it is challenged, for example
through the NHS trust’s complaints procedure, or by a complaint to the
GMC.

 

The GMC’s guidance makes clear that once a DNACPR decision has been made,
the doctor has a duty to make it clear to the healthcare team (and if
appropriate the patient and those close to the patient), that it applies
only to CPR and does not mean that other treatments will be withdrawn or
withheld.

 

The Mental Capacity Act 2005 enables people to make a decision in advance
to refuse treatment if they lose capacity in the future.  This is called
an advance decision, sometimes referred to as a ‘living will’.  

 

Where someone wants to make an advance decision to refuse life-sustaining
treatment, such as CPR, the Act requires some additional safeguards:

 

* it must be in writing, and if the person is unable to write, then
someone should write it down for them;

* the person must sign the decision, or if unable to do so, direct
someone to sign on their behalf;

* the person making the decision must sign in the presence of a witness
and the witness must then sign the document; and

* the advance decision must include a clear statement from the person
making the advance decision that it is to apply to the specific
treatment, even if life is at risk.

 

Please note that the Freedom of Information Act only applies to recorded
information such as paper or electronic archive material.  As your
correspondence asked for general information, rather than requesting
recorded information or documentation, it did not fall under the
provisions of the Act.

 

I hope this reply is helpful.

 

Yours sincerely,
 
Malcolm Jones
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care

 

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Dear Department of Health and Social Care,

I don't see how it is legal for the government to allow doctors to place DNAR onto people. And for your department to say its an agreement with; British Medical Association, the Royal College of Nursing and the Resuscitation Council, which are private members clubs that Doctors are members of.

It must be written into law and cannot be legally backup with the named associations if a doctor has the right to place someone on a DNAR.

Again please provide what the department has in place to prevent doctors from placing people on DNAR that causes the death.

Yours faithfully,

Joe Jordan

Department of Health and Social Care,

 

Our ref: DE-1119428

 

Dear Mr Jordan,
 
Thank you for your further correspondence of 11 February about Do Not
Attempt Resuscitation Orders.

 

The Department of Health and Social Care does not issue national guidance
on this issue.  Rather, it has commended to NHS trusts the expert advice
provided in the joint guidance from the Resuscitation Council (UK), the
British Medical Association and the Royal College of Nursing Decisions
relating to cardiopulmonary resuscitation (2014).  The joint guidance has
provided a sound framework to support these decisions and for
communication with the patient or those close to the patient. 

 

Cardio-pulmonary resuscitation is a treatment and, as with all treatments,
a doctor is not obliged to provide a treatment that he or she does not
consider to be clinically appropriate.  However, there is now a clear
requirement on clinicians to discuss the matter with the patient (or those
close to the patient if the patient lacks capacity) before a Do Not
Attempt Cardio-Pulmonary Resuscitation (DNACPR) decision is made, where
this is practicable.

 

If healthcare professionals make a DNACPR decision on the basis that CPR
will not work, they should inform the patient and/or those close to the
patient.

 

I hope this reply clarifies the situation.

 

Yours sincerely,
 
Malcolm Jones
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care

 

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dangos adrannau a ddyfynnir

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Dear Department of Health and Social Care,

Again,

I don't see how it is legal for the government to allow doctors to place DNAR onto people. And for your department to say its an agreement with; British Medical Association, the Royal College of Nursing and the Resuscitation Council, which are private members clubs that Doctors are members of.

It must be written into law and cannot be legally backup with the named associations if a doctor has the right to place someone on a DNAR.

Again please provide what the department has in place to prevent doctors from placing people on DNAR that causes the death.

Yours faithfully,

Joe Jordan

Department of Health and Social Care,

 

Our ref: DE-1124854

  

Dear Mr Jordan,
  
Thank you for your further correspondence of 19 March about Do Not Attempt
Resuscitation (DNAR) orders.

With regard to legality, policies and individual decisions about
cardio-pulmonary resuscitation must comply with the Human Rights Act 1998.
 This Act incorporates the majority of rights set out in the European
Convention on Human Rights into UK law.  In order to meet their
obligations under the Act, healthcare professionals must be able to show
that their decisions are compatible with the human rights set out in the
Articles of the Convention.

 

With regard to measures in place to prevent doctors placing people on DNAR
orders inappropriately, as stated previously (our ref: DE-1114863) it is
for NHS trusts to satisfy themselves that they have appropriate
arrangements in place and that those arrangements are suitable for the
purposes of clinical governance.

 

The Freedom of Information Act applies only to recorded information such
as paper or electronic archive material.  As your correspondence asked for
general information, rather than requesting recorded information or
documentation, it still did not fall under the provisions of the Act.

 

I hope this reply clarifies the situation.

 

Yours sincerely,
  
Malcolm Jones
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care

 

-------------------------------------------------------------------------------------------------------------------------

Please do not reply to this email. To contact the Department of Health and
Social Care, please visit the [1]Contact DH section on Gov.uk

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dangos adrannau a ddyfynnir

Incoming and outgoing e-mail messages are routinely monitored for
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