The Power of the DNR

Stop me if I’m wrong but I visit the doctor, go to A&E – read enlist medical expertise – because they are just that: experts. With the majority of the population not undergoing multiple years of medical training I expect my doctors and nursers, healthcare practitioners etc. to know better than me. I approach them precisely because they have the knowledge and skills that I do not.

Whether or not we’ve given this much thought, by asking for medical help there is an implied contract of trust. If I’m not going to receive reliable and trustworthy medical information I may as well turn to my laptop for help and google my symptoms (never a good idea!). By submitting myself to someone else’s medical training I am trusting them with my health. I am giving them a substantial amount of power which I expect them not to abuse; hence the Hippocratic oath.

But what about when this goes wrong? An article that caught my eye was the NHS’s abuse of a DNR (do not resuscitate) in the case of Andrew Waters. Andrew’s family discovered that hospital staff had put a DNR – an order not to resuscitate – on Andrew’s medical file without consulting the family; a breach of human rights and a breach of trust. Although the order not to resuscitate did not have any bearing on Andrew’s later death his family were shocked that the DNR had been placed on his file without their consultation. It listed his Down Syndrome and learning difficulties as a reason. In fact, the family only found out about it when his carer found it on a form in Andrew’s bag upon discharge from the hospital.

As the above case attests medical staff at this specific hospital made a unilateral decision when the family should have been consulted. This, to my mind, is a huge breach of trust. The right to decide on a DNR should not, and does not, sit with the healthcare expert. Despite this it should not be overlooked that in many cases hospital staff take the time and effort to provide information and advise families and patients about DNR.

The other shocking element to this story is that Andrew’s Down Syndrome and learning disabilities was cited among the reasons for the DNR. As Michael Waters stated in an interview: “People with Down’s Syndrome deserve the right to live like you and me.” The learning disability charity Mencap stated that this was “unacceptable” and that this is not the first time they have heard of people losing loved ones due to the inappropriate use of a DNR, applied without family permission, with learning disabilities used as a reason.

As I’m sure you’ll all agree it is horrific to think that this kind of thing still happens today. This seems like it should be a relic of an old medical model and appears almost medieval to me. I’d like to think that we are enlightened population that appreciate the differences within our society and choose to celebrate rather than minimize them. In history lessons we’ve all heard about different attempts by historical figures who have tried to ‘cleanse’ our population. By mentioning these atrocities I do not mean to suggest that the abuse of a DNR, whether or not the patient has learning disabilities, has any relation to previous systematic atrocities but I can’t help but see the link. By assigning a DNR to someone’s medical file and placing amongst the reasons their learning disabilities I struggle to see the positive. I know that in some cases the DNR is chosen by the patient or family to protect the dignity of the sufferer but I am specifically talking about when this power is abused. I hope this is the last time we will see such an article in the news. Until such time as this happens you will find me struggling to understand how this can happen.

To read the BBC article on this case click here.

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One thought on “The Power of the DNR

  1. *power second paragraph

    I agree fully with the sentiment you put across in this article. My positive from all this and from the cases of the southern trust (mental health deaths not being investigated) is that hopefully people will realise that ‘person centred care’ is a ridiculous term for what you receive from the hospital/clinical service. A new term is needed that reflects the amount of trust you are putting in the practitioners that are requesting aid from.

    There also needs to be much more preventative measures but that is a while other conversation.

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