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Court blocks judicial review over 'do not resuscitate' orders Court blocks judicial review over 'do not resuscitate' orders
(about 2 hours later)
A family's attempt to force the government to adopt a nationwide policy requiring hospitals to consult patients and relatives before making "do not resuscitate" orders has been blocked by a high court judge. A family's attempt to force the government to adopt a policy requiring hospitals to consult patients and relatives before making "do not resuscitate" orders has been blocked by a high court judge.
Mrs Justice Nicola Davies said a judicial review involving the health secretary, Jeremy Hunt, on the legal issues in the case of 63-year-old Janet Tracey, who had a DNR notice put on her file without her knowledge, would be neither "appropriate nor proportionate".Mrs Justice Nicola Davies said a judicial review involving the health secretary, Jeremy Hunt, on the legal issues in the case of 63-year-old Janet Tracey, who had a DNR notice put on her file without her knowledge, would be neither "appropriate nor proportionate".
Tracey was admitted to hospital with a broken neck sustained in a car accident two weeks after she had been diagnosed with terminal lung cancer. Tracey was admitted to hospital with a broken neck following a car accident two weeks after she had been diagnosed with terminal lung cancer.
Eight days later, after she was transferred to Addenbrooke's hospital in Cambridge, a DNR notice was put on her medical record, without either Tracey or her family being consulted. Eight days later, after she was transferred to Addenbrooke's hospital in Cambridge, a DNR notice was put on her medical record without either Tracey or her family being consulted.
When the family objected, it was removed. However, three days later a second DNR notice went on the file, this time after talks with the family but not with the patient, who they felt was too ill to discuss it. When the family objected, it was removed. A second DNR notice went on the file three days later, after talks with the family, but not with the patient, who they felt Tracey too ill to discuss it. The family sought a judicial review to obtain a clear and consistent policy across the NHS on DNR orders, and wanted Hunt to give evidence.
The family sought a judicial review in the hope of obtaining a clear and consistent policy across the NHS on DNR orders, and wanted Hunt to give evidence.
At the moment such decisions are a matter for individual healthcare trusts, and policies vary. Addenbrooke's written policy is that patients must be consulted if they are in a fit state to understand what is being proposed.At the moment such decisions are a matter for individual healthcare trusts, and policies vary. Addenbrooke's written policy is that patients must be consulted if they are in a fit state to understand what is being proposed.
The judge said a judicial review was not warranted. Earlier, in her findings of fact, Davies ruled that the first DNR order had "minimal causative effect", as the notice was cancelled five days later when her family objected, and was not acted upon.The judge said a judicial review was not warranted. Earlier, in her findings of fact, Davies ruled that the first DNR order had "minimal causative effect", as the notice was cancelled five days later when her family objected, and was not acted upon.
On that occasion, the doctor involved had spoken to Tracey's daughter and believed she had agreed to the notice. Before the second DNR notice was imposed, hospital staff spoke to the family but not to Tracey.On that occasion, the doctor involved had spoken to Tracey's daughter and believed she had agreed to the notice. Before the second DNR notice was imposed, hospital staff spoke to the family but not to Tracey.
The judge accepted that the patient was by that time very ill and did not want to discuss it. "The evidence of medical and nursing staff was that Tracey and her family were in denial as to her prognosis," said the judge. "The fact is clearly documented in the medical records, I find it is also reflected in the evidence of the family, in particular their stated belief that having been discharged from hospital, Mrs Tracey could 'get back on her feet'." Tracey died two days later.The judge accepted that the patient was by that time very ill and did not want to discuss it. "The evidence of medical and nursing staff was that Tracey and her family were in denial as to her prognosis," said the judge. "The fact is clearly documented in the medical records, I find it is also reflected in the evidence of the family, in particular their stated belief that having been discharged from hospital, Mrs Tracey could 'get back on her feet'." Tracey died two days later.
Philip Havers QC had urged the judge to give the go-ahead for a judicial review, saying the issue was not academic but of real concern to many patients, their relatives and doctors.Philip Havers QC had urged the judge to give the go-ahead for a judicial review, saying the issue was not academic but of real concern to many patients, their relatives and doctors.
Lord Faulks QC, for Cambridge University Hospitals trust, said there was certainly a public interest in such delicate and sensitive matters but that did not justify the court involving itself in rewriting policy.Lord Faulks QC, for Cambridge University Hospitals trust, said there was certainly a public interest in such delicate and sensitive matters but that did not justify the court involving itself in rewriting policy.
The judge said such a hearing would involve the court grappling with issues of policy and clinical decision-making on the basis of limited evidence. The public interest would not be served by embarking upon a wide-ranging inquiry on such a basis.The judge said such a hearing would involve the court grappling with issues of policy and clinical decision-making on the basis of limited evidence. The public interest would not be served by embarking upon a wide-ranging inquiry on such a basis.
Lawyers for David Tracey, Janet's husband, said they would go to the court of appeal. Merry Varney, of the law firm Leigh Day, said: "We are astounded and disappointed by this decision to dispense with the legal hearing. Lawyers for David Tracey, Janet's husband, said they would go to the court of appeal. Merry Varney, of the law firm Leigh Day, said: "We are astounded and disappointed by this decision to dispense with the legal hearing.
"Whilst the judge found that a DNR order was placed on the file of our client's late wife, a woman with full mental capacity who had expressed a wish to be kept informed, without her knowledge or without any consultation with her, the judge further found that it is neither appropriate nor proportionate to look further at the legal issues that arise from this."Whilst the judge found that a DNR order was placed on the file of our client's late wife, a woman with full mental capacity who had expressed a wish to be kept informed, without her knowledge or without any consultation with her, the judge further found that it is neither appropriate nor proportionate to look further at the legal issues that arise from this.
"We shall be seeking an appeal and remain confident that the lawfulness of imposing such an order on a patient is a matter the court should consider.""We shall be seeking an appeal and remain confident that the lawfulness of imposing such an order on a patient is a matter the court should consider."