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Health workers should not be allowed to breach the human rights of vulnerable patients, and their family members, by preventing them from being involved in any decision about resuscitation, the Equality and Human Rights Commission will say today.
The Commission is intervening in a Court of Appeal case which revolves around whether seriously ill patients and their loved ones have the right to be consulted about the use of Do Not Resuscitate Notices (DNR).
The case (Tracey v Cambridgeshire NHS Foundation Hospital Trust) involves a terminally ill woman who had a DNR notice placed on her notes, with neither her nor her family’s knowledge, by doctors at Addenbrooks hospital.
She objected to it when she found out and it was removed, only to be replaced with another a few days later. She died without being resuscitated within a few days of the second notice being placed on her notes.
The Commission believes that being able to make a decision about whether a person’s life is worth living is a fundamental right protected under Article 8 of the Human Rights Act, which covers respect for private and family life and extends to personal autonomy relating to decisions about life or death. Such decisions should, where possible, rest with patients rather than be taken by doctors alone.
The Commission is the national body that promotes and enforces the laws that protect everyone’s right to dignity and respect. In its submission to the Court, it will argue that where it is considered unlikely that Cardiopulmonary Resuscitation (CPR) will be successful (that is, it will not restart the heart and breathing) then patients with capacity should be told that this is the view. They should be advised of their right to a second opinion and where they do not have capacity their family or advocate should be consulted. It should only be in exceptional circumstances that the patient's opinion is not sought.
The Commission will argue that, equally, where a clinician considers CPR might work then the patient's views as to whether or not a DNR Notice is used should also be integral to the decision.
The Commission will further call for clear and consistent national and local guidance which uses understandable terminology so that patients can give informed input.
Addenbrooks said at a previous hearing that out of the 68 per cent of the population who die in hospital, 80 per cent have DNR notices. However, the Department of Health does not collect these figures centrally.
Rebecca Hilsenrath, Chief Legal Officer for the Equality and Human Rights Commission, said:
“Human Rights laws exist to protect everyone. Being consulted, where possible, on whether our life is worth living is a fundamental right we should all expect.
“Health professionals of course have a valuable role in providing advice, but this should not lead to preventing someone from exercising choice in respect of their life or death.
"The Commission is intervening in this case to ensure that patients' human rights are not breached by a lack of clear policy, and that decisions about carrying out CPR are made in the light of the patient’s wishes. Decisions should not be made solely by clinicians, although the ultimate judgement is theirs."
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