A chilling new report states the National Health Service -- the national healthcare system of the U.K. -- ordered care homes across the country to place their residents under "do not resuscitate" (DNR) orders at the height of the coronavirus pandemic. According to the Queen's Nursing Institute, officials of the NHS pressured around one in 10 care homes to introduce DNRs without permission from the residents, family members and even fellow staff. The officials also said that the move was made to free up hospital beds for other COVID-19 patients.
In an interview with the London Telegraph, Alison Leary, a professor at London South Bank University and the author of the damning report, also called for an investigation on the matter. While the British Medical Association maintains that a DNR order should be made after talking with the patient or their family, the practice has been controversial in the U.K., especially during the COVID-19 pandemic. Recently, the NHS was forced to issue new guidance on DNR orders after a woman sued the government over its failure to provide consistent advice on the matter.
In her report, Leary surveyed 128 nurses and care home managers, all of whom worked either in elderly homes or institutions that took care of younger people with cognitive disabilities. One respondent said that they challenged the order to place DNR orders for all residents, saying the practice was unethical, while another reported that DNRs were put in place without consent from the family or discussions with care home staff.
In addition, the respondents said that some hospitals refused to admit care home residents at the height of the pandemic, even for non-COVID-19 conditions. Care home staff reported having a hard time setting appointments with general practitioners for elderly residents. (Related: London struggles to cope with an ‘explosion’ of coronavirus cases in the city: Prime Minister Johnson puts city on lockdown.)
“Do not resuscitate orders should, wherever possible, be made in consultation with the person concerned and their family and be based on fitness to be treated, as well as personal preference,” said Deborah Alsina, chief executive of the nonprofit Independent Age.
Report highlights egregious practice on DNR orders
Leary, who teaches healthcare and workforce modeling, was surprised with how many people came forward with their concerns, saying that she expected only one or two cases. The fact that DNRs were issued for whole populations -- even imposed without consulting with the family or the patient -- was a cause for concern, she added.
This effectively meant that NHS officials could make decisions that would impact the well-being of care home residents, not only the elderly but also those with cognitive problems, regardless of age.
This isn't the first time that the irresponsible use of DNR orders has been brought to public attention.
In April, NHS England medical director Steven Powis banned the use of blanketed DNR forms, in a letter to NHS staff. The ban came after news that a medical clinic in Port Talbot asked elderly patients to fill up forms ensuring that no emergency services will be sent the moment they contract COVID-19. In addition, a surgeon in the southwestern town of Somerset told people with autism to sign DNRs to prevent resuscitation if they fall critically ill.
In a separate instance, learning disability care provider Turning Point reported that it had received an "unprecedented" number of DNR forms, which it plans to challenge as illegal.
The United Kingdom currently has 330,967 confirmed COVID-19 cases and 41,552 deaths, according to data from Johns Hopkins University.
Learn more about the latest developments on the Wuhan coronavirus at Pandemic.news.
Sources include:
England.NHS.uk [PDF]
Please contact us for more information.