Today the Care Quality Commission published its report: Protect, respect, connect – decisions about living and dying well during COVID-19. The CQC had looked at practice around advance care planning during the COVID pandemic and focused particularly on the issue of DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders.
The CQC found that there had been more than 750 cases where DNACPR orders had been imposed without the person or their family being involved in the decision, in some instances via a blanket DNACPR approach. The report describes the distress and harm caused by this, highlighting the importance of such decisions being considered within the context of supportive advance care planning conversations between an individual, their loved ones, and health professionals.
The BGS welcomes the report and supports the recommendations. Used in the context of supportive and compassionate conversations with individuals and their families, DNACPR orders are a valuable part of good quality, person-centred care. It is important to remember that having a DNACPR order in place does not affect a person’s access to treatment that may benefit them but rather acknowledges that in some cases at the end of life, attempting resuscitation may not be appropriate and cause considerable further harm and distress. However, it is of course wrong that these orders have been imposed on anyone without them or their families being involved in the discussion.
Dr Jennifer Burns, President of the British Geriatrics Society, commented:
We are saddened to read today of the inappropriate use of DNACPR orders during the COVID-19 pandemic and the impact these have had on older people and their families. Advance care planning, which may incorporate DNACPR if an individual does not wish to be resuscitated should their heart stop, is a key aspect of healthcare for older people. It is internationally recognised as an effective, compassionate means of supporting patient choice and avoiding ineffective and invasive treatments. It must however be used in the context of a discussion between individuals, their families and healthcare professionals, helping individuals to make the decisions that are right for them. It is good that this issue is being addressed openly and important for all of us to feel able to talk about what matters most to us as we approach the end of life. Death is the natural conclusion to life and preparing for it, with those we love and with the support of health professionals, gives us a better chance of achieving a good death."