Court of Appeal Case on End-of-Life Decisions

Topics covered: Ridouts professional advice

The case of a dying woman who was not consulted before a ‘do not resuscitate’ notice, which was placed in her medical records is due to be heard in the Court of Appeal.

The family of Janet Tracey, who died from terminal lung cancer in hospital, wants a national policy which requires patients and relatives to be consulted by medical professionals before making end of life decisions.

In this particular case, Mrs Tracey was suffering from advanced lung cancer when she was taken to hospital after a serious car accident. She died in March 2011 after having two ‘do not resuscitate’ (DNR) instructions placed in her notes, prompting a dispute with her family. Mrs Tracey’s family is challenging the lawfulness of the ‘do not resuscitate’ policy, claiming that the first notice breached her human rights.

As well as arguing for a national policy in England, the case will also look at the issue of involving patients in the decision-making process and giving them clearer information. The family’s solicitor said it was important to establish whether patients had a right “to know doctors are contemplating withdrawing CPR from them, to have an opportunity to give their views, to know the weight attached to those views, to know what the final decision is, and what to do if they disagree.”

The family says it hopes to bring more clarity to end-of-life decisions after its long-running legal challenge over the way doctors determine whether to attempt resuscitation of critically ill patients.

There is UK-wide guidance for health professionals on how they should determine whether to attempt cardio-pulmonary resuscitation (CPR), but in England official policy is left to local NHS trusts.

Kate Masters, one of Mrs Tracey’s four daughters, said the family had realised as the case progressed how many people were affected by DNRs every year. She said that the, “stats we were given were that roughly seven out of 10 people die in hospital and that 80% of that number die with a ‘do not resuscitate’ on their files. That is a lot of people. An issue like that, when it comes to the end of life, needs clarity. At the moment we don’t feel there is any. There certainly wasn’t any for Mum, or for us.”

Kate Masters said that the issue was not about giving consent. She said: “It is a decision that the doctors make because they think CPR would be harmful or it wouldn’t work … There is no obligation at the moment for them to communicate that to you, to discuss it with you or find out your wishes. Yet what they try to do is decide what would be in your best interests, what quality of life you will accept, and things they really can’t know without having a chat with you.”

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