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Thousands 'not told about' do not resuscitate orders 'Unacceptable' that families 'not told of resuscitation plans'
(35 minutes later)
Thousands of people in England are having "do not resuscitate" orders imposed on them without their family's consent, an audit has found. Thousands of people in England have had "do not resuscitate" orders imposed on them without their family's consent, an audit of dying patients has found.
The Royal College of Physicians' audit of 9,000 dying patients found one in five families had not been told orders had been imposed on their relative. In about 200,000 cases a year where an order is given not to revive a patient, a fifth of families had not been told, The Royal College of Physicians found.
Prof Sam Ahmedzai told the Telegraph it is "unforgivable" not to tell families. Report author Prof Sam Ahmedzai said hospitals must "do better", and it was "unforgivable" not to tell families.
NHS England said there had been improvements in end-of-life care, but that more could be done. NHS England said end-of-life care had improved, but more could be done.
The audit estimated that 200,000 patients a year are issued with an order not to attempt to resuscitate them if they stop breathing or their heart stops. The audit estimated that 200,000 patients a year are issued with an "do not resuscitate" order (DNR) - which means medical staff will not to attempt to bring the patient back to life if they stop breathing or their heart stops.
A good death: Can guidelines really help?A good death: Can guidelines really help?
'My brother's Do Not Resuscitate order was horrific''My brother's Do Not Resuscitate order was horrific'
Professor Ahmedzai, chairman of the audit, said in many cases there was no relative available, or families could not be contacted in time. Professor Ahmedzai, chairman of the audit, said in many cases there was no relative available to discuss the decision, or families could not be contacted in time.
However, doctors and nurses needed to "do better" in terms of communicating with family members, as current practices were "not really acceptable", he said.However, doctors and nurses needed to "do better" in terms of communicating with family members, as current practices were "not really acceptable", he said.
"I think everybody has the spirit and the wish to do it. It's just that doctors and nurses are very busy in the front line," he said."I think everybody has the spirit and the wish to do it. It's just that doctors and nurses are very busy in the front line," he said.
"They are having to tend to lots of other things, including trying to cure patients alongside caring for those who are dying. And one of the things that goes when we are very, very busy is that attention to communication.""They are having to tend to lots of other things, including trying to cure patients alongside caring for those who are dying. And one of the things that goes when we are very, very busy is that attention to communication."
There are large training programmes across the country to try to improve communication with families, he said.There are large training programmes across the country to try to improve communication with families, he said.
DNR - Do Not ResuscitateDNR - Do Not Resuscitate
DNRs are "Do Not Resuscitate" orders. A DNR order on a patient's file means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering.DNRs are "Do Not Resuscitate" orders. A DNR order on a patient's file means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering.
The usual circumstances in which it is appropriate not to resuscitate are:The usual circumstances in which it is appropriate not to resuscitate are:
Guidelines issued by the British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussion with patients or their family.Guidelines issued by the British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussion with patients or their family.
Read more from the BBC about DNRsRead more from the BBC about DNRs
Tony Bonser, who has campaigned for better end-of-life care after losing his son Neil to a rare form of cancer, said it was crucial that doctors were open and honest with relatives as early as possible.
"It will be a clinical and medical decision always, because they have the understanding, but it really must be discussed because otherwise it leaves people with so many bad memories, so much anger and so much guilt after the person they love has died."
Mr Bonser said in the case of his son "the decision was made about him and we weren't part of that discussion".
'Too late'
In 16% of the 9,000 cases audited, the study also found there was no record of a conversation with the patient about the order.In 16% of the 9,000 cases audited, the study also found there was no record of a conversation with the patient about the order.
Professor Ahmedzai said doctors needed to be more open with dying patients - particularly as half of patients identified as likely to be dying were dead within a day.Professor Ahmedzai said doctors needed to be more open with dying patients - particularly as half of patients identified as likely to be dying were dead within a day.
"This is being done very late in the day - as doctors we just don't like to face up to it," he added."This is being done very late in the day - as doctors we just don't like to face up to it," he added.
'More to be done' An NHS England spokeswoman said there had been some improvement in the care provided, "but there is clearly more that can be done".
An NHS England spokeswoman said: "We welcome the results of this audit, which we commissioned, and which shows there has been some improvement in the care provided. The snapshot of end-of-life care showed "clear variations in the support and services received across hospitals and areas where improvements must continue to be made", she said.
"But there is clearly more that can be done.
"Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made."
In June 2014, the Court of Appeal in England ruled doctors have a legal duty to consult and inform patients if they want to place DNR order on their medical notes.In June 2014, the Court of Appeal in England ruled doctors have a legal duty to consult and inform patients if they want to place DNR order on their medical notes.
The issue was raised by a landmark judgement that found doctors at Addenbrooke's Hospital, in Cambridge, had acted unlawfully in the care of Janet Tracey.The issue was raised by a landmark judgement that found doctors at Addenbrooke's Hospital, in Cambridge, had acted unlawfully in the care of Janet Tracey.
In December, East Kent Hospitals NHS Trust apologised for placing a DNR order on a patient with Down's Syndrome - having listed his learning difficulties among the reasons for doing so.In December, East Kent Hospitals NHS Trust apologised for placing a DNR order on a patient with Down's Syndrome - having listed his learning difficulties among the reasons for doing so.
Have you been affected by the issues raised in this story? You can email haveyoursay@bbc.co.uk with your comments.Have you been affected by the issues raised in this story? You can email haveyoursay@bbc.co.uk with your comments.
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