Ensuring rights are upheld in difficult medical decisions

Should patients and their families have to be consulted when taking decisions regarding life sustaining treatment?

While in hospital Mrs Tracey had a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) notice placed on her notes without her knowledge.

This case comes within our core priority aim – upholding the system of equality and human rights protections.

We intervened using our powers under section 30 of the Equality Act 2006.

The Court of Appeal decided Mrs Tracey's Article 8 rights were engaged and the Trust violated that right by failing to involve her in the process which led to the first notice.

Even if the treating team believe that the treatment is futile there should be a presumption in favour of patient involvement. There needs to be convincing reasons not to involve the patient, as this gives the patient the possibility of seeking a second opinion. However this does not alter the position that clinicians cannot be forced to give CPR.

Doctors should be wary of excluding patient involvement on the grounds that it may distress them. Distress must be likely to cause the patient a degree of physical or psychological harm.

The outcome means that health workers should involve patients in any decision about use of DNACPR notices. There should be convincing reasons if this does not happen and causing distress is not a sufficient reason. The rights of patients to be consulted should be set out in a clear and accessible policy. This should be directed at patients and copies automatically made available to them and their families.