Compassion in Dying welcomes Court of Appeal decision on Tracey, confirming that competent patients must be consulted on decisions about their end of life care

“Today’s judgment from the Court of Appeal states that the duty to consult patients should involve a discussion about the patient’s wishes and feelings, and that this is best undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as a patient’s circumstances change.”

The Court of Appeal has today ruled that doctors acted unlawfully in the case of Janet Tracey, by placing a ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) order on her records without consulting her or her family.

At the heart of Dignity in Dying and Compassion in Dying’s work is patient choice, and we welcome patients’ views being heard and respected in relation to decisions on end-of-life care and treatment.

Sarah Wootton, Chief Executive of Dignity in Dying and Compassion in Dying, said:

“This ruling recognises the importance of communication and the involvement of patients in clinical decision-making about end-of-life issues.  Communication is paramount, and doctors must raise these issues with competent patients and their families where appropriate, even if these conversations are distressing and difficult for doctors to introduce.

“Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) orders are sometimes considered in the best interests of patients facing the end of their lives who lack capacity or who may not be able to give their views due to the nature of their illness.  In these instances it is very helpful if the patient has made their wishes known in advance in an Advance Decision to Refuse Treatment, or via a Lasting Power of Attorney so that the doctors have access to clear information about the patient’s wishes to inform their decision-making.

“Today’s judgment from the Court of Appeal states that the duty to consult patients should involve a discussion about the patient’s wishes and feelings, and that this is best undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as a patient’s circumstances change.

“Most people who contact Compassion in Dying’s end-of-life information line do so for support or tools to make their end-of-life decisions known in advance via an Advance Decision to Refuse Treatment, and the majority wish to refuse CPR.  This is evidenced in opinion polls showing that the vast majority of people would choose comfort care only at end of life.”

“Given that the imposition of a DNACPR notice is something that will happen to many people, and that at the time it is discussed, the patient may not be able to give his or her views due to illness and incapacity, it is even more important that those wishes are set out in advance in an Advance Decision, or the patient appoints an LPA, so that the doctors have access to clear information about the patient’s actual or likely wishes to inform their decision-making.”

***ENDS***

For all media enquires please contact Compassion in Dying Press Manager Jo Cartwright on 02074797737 or jo.cartwright@compassionindying.org.uk

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 legal 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 is the sister organisation of Dignity in Dying and was set up to help people exercise their rights and choices under the current law.

For more information on Compassion in Dying visit www.compassionindying.org.uk

Dignity in Dying
Dignity in Dying campaigns for greater choice, control and access to services at the end of life including the option of assisted dying for terminally ill, mentally competent adults within strict legal safeguards. Dignity in Dying has over 25,000 supporters and receives its funding entirely from donations from the public.

For more information on Dignity in Dying visit www.dignityindying.org.uk

The End-of-Life Rights Information Line
The End-of-Life Rights Information Line is available on freephone 0800 999 2434, or by emailing info@compassionindying.org.uk or writing to Information Line, Compassion in Dying, 181 Oxford Street, London W1D 2JT.

The phone-line is open between 11am and 3pm Monday to Friday.

Advance Decisions
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.

Free Advance Decisions are available by calling the Information Line or to download from www.compassionindying.org.uk.

Lasting Powers of Attorney
A Health and Welfare Lasting Power of Attorney (LPA) is a legal document that gives one of more trusted persons the legal power to make decisions about your health and welfare if you lose the capacity to do so yourself.  An LPA cannot be used until is it registered with the Office of the Public Guardian.  LPAs can make decisions for you when you lack the mental capacity to do so yourself, including the withdrawal of life-prolonging treatment.

The Janet Tracey case
Mrs Tracey was made subject to two DNACPR notices while she was a patient at Addenbrookes Hospital. Her family asked the Court of Appeal to determine that when the first DNACPR notice was applied, the hospital breached Mrs Tracey’s rights under Article 8 ECHR.

Paragraph 99 of the judgement states: “The duty to consult … involves a discussion, where practicable, about the patient’s wishes and feelings that is better undertaken at the earliest stages of the clinical relationship so that decisions can be reviewed as circumstances change.  That involves an acknowledgement that the duty to consult is integral to the respect for the dignity of the patient.”