Bioethics Blogs

The Wrongness of Do Not Resuscitate Orders Being Ignored

Guest Post by Joseph Bowen

Joseph is a BPhil Student studying at Oxford University.

Following a surprise inspection of Colchester General Hospital by the Care Quality Commission (CQC) on Friday 14th November, it was reported that inspectors had found that some patients (“elderly people, some [suffering from] dementia”) had been inappropriately restrained, and/or sedated without consent, and that ‘Do Not Resuscitate’ (DNR) notices were being disregarded. What struck me about this case is that, while all are horrible practices, the DNRs being ignored seemed worse than the inappropriate restraint and sedation without consent.

To begin with I would like to say that this post does not seek to condemn any of the staff’s actions all things considered; sitting in front of my computer now, I cannot even begin to imagine the pressure of working in an A&E and/or any other hospital ward – let alone an oversubscribed A&E ward as the CQC’s report found. That said, I am interested as to what’s behind my reaction to this case.

A DNR instructs health care professionals to withhold ‘Cardiopulmonary Resuscitation’ (CPR) and ‘Advanced Cardiac Life Support’ (ACLS) (and ‘Intubation’, where a tube is inserted into the windpipe to maintain an open airway, sometimes additionally indicated by DNI) were a patient’s heart to stop or were the patient to stop breathing. Where DNRs are sometimes understood as an ‘omission of action’ by patients and their families, some propose changing the term to the less emotively-charged ‘Allow Natural Death’. The DNR notice is brought about following a dialogue between the patient, their families, and healthcare professionals; where a patient cannot be involved in discussions it can be mandated by the patient’s family (more specifically, following recent changes, their ‘Health and Welfare’ power of attorney).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.