Revival of confidence.

Abstract

When Janet Tracey was taken to hospital after a serious car accident in 2011, a do not attempt cardiopulmonary resuscitation (DNACPR) order was placed on her notes. Ms Tracey had terminal lung cancer, but her family said she was not consulted, and the order was cancelled after they complained. A second order was later put in place, with the agreement of the family, and Ms Tracey died at Addenbrooke’s Hospital in Cambridge two days later, aged 63. This case led to a legal fight that ended when the court of appeal agreed with Ms Tracey’s relatives that her human rights had been violated with the first DNACPR order placed without her consent. The judgement stated that when it came to a decision that would ‘potentially deprive the patient of life-saving treatment, there should be a presumption in favour of patient involvement’. The Tracey family’s experience and the legal case have prompted an update of CPR guidance for healthcare staff. Decisions Relating to CPR, issued by the Resuscitation Council UK, the British Medical Association and the RCN, emphasises the importance of patient and relative involvement in decisions on whether to use DNACPR notices. It stresses that, where possible, decisions about whether to carry out CPR for people approaching end of life should be made in advance. Avoiding discussions about this area denies patients and their families the opportunity to be involved in decisions, and could lead to unwanted or inappropriate steps being taken. Survival rates from the time of cardiorespiratory arrest to being discharged from hospital iS TO CK