DNAR can they put this on my LO’s file without my consent as I hold LPOA?

[mydiamondmum]

DNAR (do not resuscitate) put on my LO’s file without my consent as LPOA. My LO has moved to a new care home and I had a meeting with the deputy manager, it was supposed to be a care plan meeting but consisted of me being talked at for 20mins. The subject of do not resuscitate came up and I said I would need to give it some thought find out more about it and talk about it at a later date.

I have now discovered via a LA review report which took place after my meeting with the deputy manager that there is a DNAR in place.

How can they do this without getting my consent? Is it legal?

My LO has Alzheimer’s and mobilises with a frame indoors, she is quite upbeat and happy most of the time.

 

[mydiamondmum]

Actually I have found the answer online, so if anyone else is wondering about this here is the answer I found

What authority does a medical team have with regards to putting in place a DNR?

Medical teams have a duty to consult the person and/or their family/carers before putting in place a DNR. A High Court case in November 2015 stated that a doctor putting in place a DNR in respect of a 28 year old man with Cerebral Palsy without the knowledge of his family was a violation of his Article 8 rights, under the Human Rights Act.

 

[Rey61]

That's interesting... When my mum was in hospital dying from a rare blood cancer, we were consulted re DNR. She had been living at home. My dad had been living in a home (social services took things out of our hands and deemed him unsafe at home on account of falling - he did not have dementia) and when he was hospitalised on account of pneumonia we were told there was a DNR in place. Medical team had made the decision! We knew it would not have been in his interests at 93 in his state of frailty to be resuscitated and we would have agreed to it but were shocked we had no say. Had that patient with cerebral palsy living at home or was he in a home? We were led to believe that this was the difference between my mum's and my dad's situations.

 

[Louise7]

The hospital put a DNACPR on Mum without the family's knowledge. She was only in there for treatment to a cut eyebrow! When we found out and obtained a copy it stated that a discussion had taken place with daughter (me) and I had agreed with the decision, which isn't true. No such discussion took place.

 

[karaokePete]

This is covered by the Factsheet that can be reached with the following link - Page 13, which seems to confirm what has already been said by stating that consultation must take place.
End of life care (531)
PDF printable version

 

[Sirena]

When I had a care review meeting the manager asked me about DNaR and I answered the question then and there. She would not have overriden my wishes even if she didn't agree, as she told me she goes with what the relative decides.

In terms of medical treatment I find it quite confusing what should happen and what actually does. When my mother broke her hip the CH told me the doctor would need to get my permission for the operation to take place. When I went into the hospital there was no doctor available and the Matron said they didn't need my permission, the decision was taken by the medical team, but the doctor would call me to discuss it. But I received no call and the op just went ahead. I would of course have agreed to it anyway, but I can imagine situations where I may not agree with what they want to do.

 

[Louise7]

Consent should be sought prior to treatment but this seems to vary, dependant on the treatment. Mum was given strong anti-epileptics (despite no confirmed epilepsy diagnosis) and consent from the family was not sought - the hospital didn't even inform us that this medication was being given. We would have objected if we had been aware.

 

[notsogooddtr]

At the end of the clinicians have the final say about medical treatment. They might consult family but don't have to abide by their opinions.

 

[Louise7]

The point is that under the Mental Capacity Act if someone has lost capacity staff have to consult - or at least make an attempt to consult - POA's/relatives/carers. That is the law, regardless of whether the doctors have the final say or not. Obviously if it is an emergency situation that's different but legally they have to consult otherwise there is potential for abuse, for example putting a DNAR on someone and then using it as justification not to treat them.

 

[notsogooddtr]

That's what I said. DNAR only covers recusitation following cardiac arrest. It doesn't mean any other treatment won't be given eg antibiotics.

 

[Louise7]

Well that's what supposed to happen but from personal experience the reality can unfortunately be very different.

 

[Elle3]

From my experience. The care home nurse my dad is in, asked me about my thoughts on a DNAR and hospital treatment first and then they set up an appointment with the Practice Dr to formalise it. They also explained and discussed it with me. I agreed to the DNAR and said I did want dad to go to hospital if a medical need arose. I don’t have LPA for health and welfare but I’m still always consulted.

 

[Saffie]

Consultation doesn’t mean permission so a professional may still impose a DNR if they feel that resuscitation would not be in the best interest of the patient.
Doctors may also refuse further medical interventions for the same reason. This has happened recently with my SiL’s mother who did not have dementia and nor did she or the family agree to a DNR being put in place , in fact they refused it.
However, I doubt that anyone in a care or nursing home has the right to decide.

 

[Sirena]

At the end of the clinicians have the final say about medical treatment. They might consult family but don't have to abide by their opinions.

But it would be nice to be consulted, and it seems to be completely random whether you are or not.

As you say, a DNaR does not mean refusing all treatment, but @mydiamondmum seemed to be saying it is the CH, not a clinician, who has imposed this without her consent. I was told that as I had agreed to DNaR the CH would then pass this info to the GP who may then ring me to ensure I understood what was involved (he didn't).

 

[Spamar]

When OH went into care I agreed to DNAR, but ABs were on a case to case basis. And that is what happened.

 

[Louise7]

In my Mum's case she had an easily treatment heart condition which, if treated, would significantly improve her quality of life. However a consultant placed a DNACPR on without the family's knowledge and then 'delayed' forwarding a referral to cardio for months. When the issue was finally resolved and Mum was seen by cardio they recommended a pacemaker which is going to be fitted later this month, but could have been fitted 6 months earlier. So whilst it is understood that medical staff may make the final decision about treatment, if they do this without failing to consult with family then there is the risk that they are making decisions based on their own personal views, and outside the scope of their own technical expertise, rather than from an informed 'best interests' point of view.

The family will be submitting a complaint about the unlawful DNACPR so it will be interesting to see what the outcome will be.

 

[Saffie]

@mydiamondmum I think the short answer to your original question is that yes, they can place a DNR without the consent of someone with LPA but not without consulting them.

 

[Louise7]

DNR does really only apply to resuscitation.

Yes, but that doesn't stop people placing their own 'interpretation' on things. Difficult to say whether it's due to a lack of knowledge about the law, or a disregard for it. It does seem somewhat 'unorthodox' though to place a DNACPR on and then delay treatment of a condition that could cause cardiac arrest if left untreated