The question is ‘which Bastard’ ordered the ‘do not resuscitate’ notices for Covid patients with learning disabilities

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Image credits (Claudio Furlan/LaPresse via AP)

Yes, we are all furious but where did the ordered come from who signed this blanket death warrant?

People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog Mencap.

Mencap has said they received multiple reports from coronavirus patients with learning disabilities who were told they would not be resuscitated if their health deteriorated. 

“Throughout the pandemic, many people with a learning disability have faced shocking discrimination and obstacles to accessing healthcare, with inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices put on their files and cuts made to their social care support,” Edel Harris, Mencap’s chief executive, told The Guardian.

The Care Quality Commission said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.

“There is evidence of unacceptable and inappropriate DNACPRs being made at the start of the pandemic,” the interim report found, adding that the practice may have caused “potentially avoidable death”.

DNACPR decisions can be made by a consultant, GP or suitably qualified nurse and should be made in consultation with the person concerned. They are a common part of end-of-life care, not least because CPR is an invasive and traumatic medical intervention and is mostly unsuccessful, saving fewer than 10% of people outside of hospital settings. But such notices should not be issued in a blanket form, the CQC said.

“It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people,” said Rosie Benneyworth, chief inspector of primary medical services and integrated care at the CQC.

“Sadly, in the experiences that people have generously shared with us, there is very real concern that decisions were made which not only overlooked the wishes of the people they affected, but may have been made without their knowledge or consent.”

The CQC cited reports that care providers and staff had raised concerns about GPs “putting blanket DNACPRs on care homes”.

DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.

The big question is who or what government body authorised and ordered this barbaric practice?

About DNACPR orders
A DNACPR decision is an instruction not to attempt cardiopulmonary resuscitation. DNACPRs are designed to protect people from unnecessary suffering by receiving CPR that they don’t want, that won’t work or where the harm outweighs the benefits. Every decision about CPR must be made on the basis of a careful assessment of each individual’s situation and should never be dictated by ‘blanket’ policies.

Wherever possible, the decision must be made in consultation with the person. If the person cannot be involved because they are not able to make relevant decisions for themselves, a best interests decision that involves those close to them or their representatives and informed by the person’s wishes, feelings, beliefs and values must be undertaken.

Source: Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic (Care Quality Commission, 2020)

NHS figures released last week show that in the five weeks since the third lockdown began, Covid-19 accounted for 65% of deaths of people with learning disabilities. Figures from the Office for National Statistics show that the rate for the general population was 39%, although the two statistics are drawn from different measurements.

Younger people with learning disabilities aged 18 to 34 are 30 times more likely to die of Covid than others the same age, according to Public Health England.

Edel Harris, Mencap’s chief executive, said: “Throughout the pandemic many people with a learning disability have faced shocking discrimination and obstacles to accessing healthcare, with inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices put on their files and cuts made to their social care support.

“It’s unacceptable that within a group of people hit so hard by the pandemic, and who even before Covid died on average over 20 years younger than the general population, many are left feeling scared and wondering why they have been left out.

“The JCVI and government must act now to help save the lives of some of society’s most vulnerable people by urgently prioritising all people with a learning disability for the vaccine.”

Professor Martin Green OBE, Care England’s chief executive, said: “As the largest representative body for independent providers for adult social care, Care England remains concerned that the government has not given individuals with a learning disability a higher level of priority for the Covid vaccine.Advertisement

“We urge the government to remove the arbitrary distinction between prioritising those with a severe or profound learning disability and those with a mild or moderate learning disability, and prioritise all those with a learning disability in priority group four. People with learning disabilities must not be overlooked at any time.”

A spokesperson from the Department of Health and Social Care said: “It is completely unacceptable for ‘do not attempt CPR’ decisions to be applied in a blanket fashion to any group of people. This has never been policy and we have taken action to prevent this from happening.

“We have asked the CQC to undertake a review of notices issued during the pandemic. This review has started and will report later this year. As this proceeds, we will continue to work across the health and care system to address the issue.”

What still remains is the question ‘WHO gave the order ‘Do not resuscitate?’

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