Court of Appeal: doctors wrong on ‘do not resuscitate’ notice

The human rights of a 63-year-old terminally-ill hospital patient were violated because she was not consulted before a “do not resuscitate” (DNR) was placed on her records, the Court of Appeal has ruled.

Three appeal judges were asked to intervene by David Tracey, who said his late wife Janet was subjected to an unlawful DNR notice at Addenbrooke’s Hospital, Cambridge.

Such notices are intended to ensure that a patient dies in a dignified and peaceful manner, but they have become the subject of controversy.

The Government and health chiefs were accused in court of failing to tackle widespread confusion and uncertainty over the imposition of notices on seriously ill patients.

Lord Dyson, Master of the Rolls, who sat with Lord Justice Longmore and Lord Justice Ryder, declared that the hospital trust “violated Mrs Tracey’s Article 8 right (under the European Convention of Human Rights) to respect for private life in failing to involve her in the process which first led to the notice”.

But the judges rejected complaints that the Government had infringed her rights in her last days by failing to promulgate national guidance on DNR notices.

A spokesman for Cambridge University Hospitals NHS Foundation Trust (CUH) said: “The Trust is considering the implications of this judgment and the next steps very carefully.

CUH chief executive Dr Keith McNeil said: “Today’s ruling hinges on a specific point of law. There was no criticism of our clinical care.

“It is a fact of life that every day people die in hospitals. From my own experience as a specialist hospital doctor, the most important thing is that these patients are treated with the utmost respect and dignity.

“End-of-life situations involve doctors and nurses having emotionally challenging but necessary conversations with patients and their families about what happens in the final stages of their care.

“Medical staff use a combination of their compassion, experience and judgment at these difficult times to try and find the right pathway for each individual patient, and provide the support needed for everybody involved.”

An emotional Mr Tracey said outside court that the ruling was “a good result”.

Asked if it would help other families, he said: “I hope it will. Patient care has got to come first, and this will bring more care to people.”

Merry Varney from law firm Leigh Day, who acted for the Tracey family, welcomed the “strong message” she said was being sent out by today’s ruling.

She said: “My client and his family are delighted that the court has recognised the need for doctors to consult patients on decisions to deny resuscitation.

“The Court of Appeal has confirmed that the way in which Janet Tracey was treated at Addenbrooke’s hospital was wrong and that she should not have been excluded from the decision-making process to place a ‘do not resuscitate’ order on her records, especially as she had stated a clear wish to be involved in her treatment.

“Janet, a care home manager, would have been horrified if one of her residents had been treated in this way and she would have fought, as her husband has, to ensure that patients have a legal right to be informed and consulted in relation to decisions to withhold resuscitation.

“It is notable that the court sought to underline that the duty to consult is an integral part of respecting a patient’s dignity and that the presumption should be that patients are informed and consulted before ‘do not resuscitate’ decisions are made.

“My client and his family welcome the strong message delivered by the Court of Appeal today, which should now bring to an end the unwelcome surprise that Janet suffered and that many other patients and families have suffered, when they discover a ‘do not resuscitate’ order has been imposed without information or consultation.”

Today, the appeal court ruled that patients should be “consulted and involved in the decision-making process” before DNR notices are placed on their records, unless a clinician considers that the consultation is likely to cause the patient physical or psychological harm.