David Tracey is bringing a claim against Cambridge University Hospitals NHS Trust following his wife’s admission to Addenbrooke’s Hospital when her notes were marked “DNR”.
She had been diagnosed with terminal lung cancer in February 2011, but was admitted after breaking her neck in a car accident in mid-2011 . Mr Tracey claims that DNR (do not resuscitate) orders were present on his wife’s medical notes without either his consent or hers, and that despite having this removed from the notes at his wife’s request, it reappeared. He maintains the NHS Trust has acted unlawfully by failing to have a standard policy on resuscitation decisions.
“DNR” is sometimes seen written in the notes or even by the bedside of terminally or critically ill patients. It is an emotive instruction and one which is often arrived at by consensus and, usually, with the patient’s or their family’s knowledge or consent. There are, however, times when a patient, injured in a serious accident or who suffers a very sudden deterioration in their health, can be in a situation where death is regarded by the medical profession as both imminent and unavoidable. In those circumstances, if there is an event which causes the patient to stop breathing or lose cardiac output, clinicians may deem it inappropriate to intervene and resuscitate a patient in the knowledge that they will very shortly die in any event. The intention is to strike a delicate balance between the physical and emotional trauma of resuscitation (for both the patient and their family) and acceptance of the inevitable. The general rule is that a DNR order is a clinical decision and therefore rests with the medical profession.
Were the case to succeed, it could have a significant impact on clinical decisions taken within hospitals, and it illustrates that even purely clinical issues must be handled with care and sensitivity by medical staff.