AWA is a 51-year-old man with Down’s syndrome who has dementia and is fed by a percutaneous endoscopic gastrotomy. Following a stay in hospital a do not attempt resuscitation (DNAR) order was discovered in his medical records. The order provided that resuscitation should not be attempted in the event of a cardio or respiratory arrest, apparently it gave his disability and learning difficulties as some of the reasons for imposing it.

The Resuscitation Council, British Medical Association and Royal College of Nursing joint statement makes it clear that a DNAR decision should be made only after careful consideration of all the relevant factors and discussion with the patient , or their close relatives/carers if the patient lacks capacity. It appears the family were not consulted in this case. They have launched a legal case claiming that the reasons given for the decision are discriminatory, and Down’s syndrome is not an appropriate ground for making a DNAR decision.

The case highlights the importance of involving patients and their families/carers when making DNAR decisions and fully documenting the decision making process. We will of course keep you informed of the progress of the case.