DNAR forms are scheduled to be replaced by Emergency Care and Treatment Plans (ECTP) but there are worries that this new form could lead to confusion with clinicians and families.
The ECTP is being developed in response to a Court of Appeal decision in June 2014 which stated that a doctor who puts a DNAR form in place without consulting the individual is breaching their human rights. The fear, attributed to both the old and new form, is that such life determinative decisions are recorded only through a tick-box exercise and without proper consultation.
The new form is more detailed and more pronounced and is designed to help the clinician navigate the recording of the decision-making process with greater accuracy. It states that there should be a record of the discussions pertaining to the DNAR; there is also a section which allows records to be inserted if the individual changes their mind- neither of which are contained on the old form.
The daughter of the individual that the Court of Appeal decision related to has expressed a fear of the exclusion of families from the decision-making process. It is difficult to see how this form would lead to this conclusion being drawn; however, what is agreed is that the process and training around the effective handling of DNAR forms in whatever guise need to be given due attention. It is inevitable that end of life care provision will increase as the nation’s elderly population continues to grow and there is a clear need for clarity around the use of DNAR forms and DNAR decision making.
A consultation on the new document is scheduled to be concluded on 29 February and responses are welcomed.