Anger after doctors put 'Do Not Resuscitate' note on records

A DAUGHTER has told of her "outrage" after discovering doctors treating her late mother did not plan to resuscitate her if she collapsed.

Barbara Evans was treated at St James's Hospital in Leeds on a number of occasions during 2006 and 2007 after being diagnosed with a tumour on her liver.

But her daughter Caroline Feeman said she was shocked to later discover DNR (Do Not Resuscitate) had been written on her medical notes during one 17-day stay on an elderly care ward in July 2006.

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The issue is being highlighted in new guidance on end-of-life care which comes into force in July. Campaigners have welcomed guidelines drawn up by the General Medical Council which emphasise that patients must be given an opportunity to discuss their wishes but still give doctors the right to exercise their own judgment in making DNR decisions.

Records for Mrs Evans, of Oakwood, Leeds, show her stay in July 2006 was the only time she had DNR written on her medical chart. She was successfully resuscitated in April 2006 and again in 2007, 10 days before she died a few days before Christmas, aged 84.

Mrs Feeman, who lives in Ohio in the United States, said: "She was not in the final stages of an incurable illness and the last notes in the chart stated that she was 'well'. "During the 17 months between the time she was designated DNR and when she died, she was able to travel, unaccompanied, to the US to visit us and to meet her great grandson for the first time."

She said it would "never, ever" have occurred to her mother to ask to be designated DNR and it did not happen when she was treated on other wards.

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"I was shocked because this issue had never been discussed with either my mother or the family," she said.

"Fortunately, my mother did not suffer an arrest but after talking to several friends and relatives I realised that the public are unaware of the fact that decisions of this nature can be made unilaterally and arbitrarily.

"My outrage at this decision lies not solely with concern for my mother but the fact that a doctor is allowed to make life and death decisions in a non-emergency situation on behalf of another human being."

She said patients should have a right to be involved in decisions and had contacted her mother's MP to press for action for a change in the law.

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The new GMC guidelines were a "step in the right direction" but she was sceptical they would work in practice. "They should be ethically and legally binding," she said.

"We feel that a reasonable resolution would be to ask all patients on admission, as they are in the US, to state their wishes on paper and if the attending physician disagrees with the patient's decision then the matter should be referred to the ethics committee on an emergent basis."

A Leeds Teaching Hospitals NHS Trust spokesman said: "It would be inappropriate to go into details of this particular case, which is the subject of an ongoing complaint.

"The trust policy states explicitly that in most cases patients should be informed of any clinical decision not to attempt resuscitation.

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"We do discuss cardiopulmonary resuscitation (CPR) decisions with patients and/or their relatives where we feel there is a genuine choice to be made – that is when we think that it could be successful, but even then the patient may not want CPR to be attempted.

"Our policy emphasises that, where there is a real, and difficult

choice to be made, the patient's view is of paramount importance. However we may feel that to attempt CPR would be medically futile, and that there is no real decision for the patient or their relatives to make. Even then, we now recommend that most patients should be told, as part of the process of keeping them informed about the seriousness of their condition.

"For some patients, for example those who know that they are

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approaching the end of their life, information about interventions that would not be clinically successful would be unnecessarily burdensome and of little or no value.

"Such patients could be distressed by receiving what could appear to be unnecessary and unhelpful information, in the same way that we would not talk about an operation or other treatment that would not help them."

The trust welcomed the new GMC guidance and would be examining it to see if its own guidelines should be updated.

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