Compassion in Dying calls for formal training for all working in emergency and end of life care on the remit of DNARs and treatment refusal.
As reported in the national media today, a Coroner has written to five organisations about the failings in the care Mrs Jean Robson received at the end of her life, in the hope that lessons can be learned to prevent the same issues occurring in the future. The case of Mrs Robson’s death has highlighted a need for greater clarity and education over patient decision-making at the end of life.
Mrs Robson died during a ‘distressing altercation’ between the staff of the care home she was living in, and her daughter, because of confusion over her end of life wishes. Mrs Robson was suffering from dementia and then developed pneumonia at the end of her life. She had made it clear to her family and medical professionals that she did not want her life prolonging by medical intervention and had made a Do Not Attempt Resuscitation (DNAR) order, but due to a communication failure the care home she returned to for her final days was not aware of this.
This case has highlighted a lack of clarity about the remit of DNAR orders, particularly for emergency healthcare professionals.
Danielle Hamm, Director of Compassion in Dying said:
“People facing the end of their lives must be confident that their wishes will be respected in their final moments, and this sad case shows that we are a long way from this being a reality in some cases. Mrs Robson had taken steps to ensure that her loved ones and those caring for her knew of her wishes if she were unable to communicate them at the time. Poor communication and a lack of coordination in end of life care led to confusion, and ultimately not the death Mrs Robson and her family would have wanted.
“Compassion in Dying provides support and tools to enable people to have control over the decisions made about their end of life. People can record their treatment wishes formally in a legally binding Advance Decision, or appoint a third party to be their Lasting Power of Attorney (LPA). Even with all of these things in place, if different care settings are not communicating effectively, people will not have the deaths that they would choose.
“What is urgently needed is education for all healthcare professionals who may play a part in a patients end of life care, and the reinforcement of the legal validity of Advance Decisions, LPA’s and DNAR’s. Healthcare professionals must be made aware that they are potentially breaking the law by ignoring a patient’s wishes to refuse treatment at the end of life.”
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The End-of-Life Rights Information Line
The End-of-Life Rights Information Line is available on freephone 0800 999 2434, or by emailing firstname.lastname@example.org or writing to Information Line, Compassion in Dying, 181 Oxford Street, London W1D 2JT. The phone-line will be open between 11am and 3pm Monday to Friday.
Compassion in Dying
Compassion in Dying is a national charity (no. 1120203) that aims to support people at the end of life to have what they consider to be a good death by providing information and support around their rights and choices. We are a leading provider of free Advance Decisions in the UK and we also conduct and review research around patient rights and choices in end-of-life care.
Compassion in Dying was set up in 2007 by the campaigning organisation Dignity in Dying to take on the charitable aspects of its activities. The two organisations now work in partnership.
While Compassion in Dying aims to increase people’s understanding of and empowerment around existing end-of-life rights through information, research and education, Dignity in Dying campaigns to extend and defend individuals’ rights at the end of life.
For more information on Compassion in Dying visit www.compassionindying.org.uk
An Advance Decision is a document that allows individuals to set out their wishes and preferences for medical treatment in advance, in the event that they become unable to communicate with their health team (for example, if they fall into a coma or develop dementia). Advance Decisions were given statutory force under the Mental Capacity Act, 2005 (in October 2007) meaning the refusal of treatment is legally binding. The Compassion in Dying Advance Decision is fully compliant with the Mental Capacity Act.
Advance Decisions are sometimes called:
- living wills;
- advance directives.
Free Advance Decisions are available by calling the Information Line or to download from www.compassionindying.org.uk.
Lasting Powers of Attorney
A Lasting Power of Attorney is a legal document. It allows you to appoint someone that you trust as an ‘attorney’ to make decisions on your behalf.
There are two types of LPA: property and financial affairs and health and personal welfare. A Lasting Power of Attorney cannot be used until it is registered with the Office of the Public Guardian.
Attorneys for health and personal welfare can make decisions for you when you lack the mental capacity to do so