CPR stands for cardiopulmonary resuscitation. It is a treatment that can be given when you stop breathing (respiratory arrest), or your heart stops beating, (cardiac arrest). CPR tries to get your breathing and heart going again.
DNACPR stands for do not attempt cardiopulmonary resuscitation. DNACPR is sometimes called DNAR, (do not attempt resuscitation), or DNR (do not resuscitate), but they all refer to the same thing. DNACPR means if your heart or breathing stops, your healthcare team will not try to restart it. A DNACPR decision should be made by you and/or your doctor or healthcare team.
“DNACPR is about CPR only. It does not mean that you will not get care and treatment. You will continue to have all the other appropriate care, treatment and support you need.” Source NHS here
In October 2020, the Department of Health and Social Care (DHSC) asked the Care Quality Commission (CQC) to review how DNRs were used during the COVID-19 pandemic, building on concerns that were reported earlier in the year. The final report from the CQC can be found here
In our opinion, this report misses a crucial area. It does not seem to address the fact that over the last year there has been a widespread disconnect in the medical profession, about what a DNR actually means, and how doctors have treated a patient who has a DNR.
Remember, a DNR means only that your heart and/or breathing should not be restarted if they stop. It DOES NOT mean that your medical treatment should be withdrawn. Neither does it mean you should be placed on nil by mouth or refused hospital admission.
In our opinion, the CQC report does not address the following issues:
- people, especially those in care, being refused admission to hospital for treatment of any illness, because a DNR had been placed on their medical records, some placed without their knowledge
- People in care homes, hospices and hospitals, being placed on end-of-life pathways because they had a DNR on their records, again some having been placed there without the patients knowledge, or the knowledge of their family
- Why so many in the medical profession have demonstrated during the last year that a DNR is a green light for them to place a person onto nil by mouth, and use midazolam and morphine as a pathway to end that person’s life
Understanding what a DNR is, is crucial to a discussion of medical practice over the last year. We have many accounts of the misuse of DNRs during this time. However, it is not just the illegal placing of them on patient’s medical records that is important. It is how this then led to a withdrawal of medical treatment for those with a DNR, during the last year, and how midazolam and morphine was then prescribed for these patients.
A withdrawal of medical treatment is never acceptable given that a DNR means only that your heart and breathing should not be started if it stops. Invoking so called end of life pathways is also not acceptable, merely because you have a DNR on your medical records.
The CQC needs to do better with their report. They urgently need to address why DNRs have led to the refusal of medical treatment for people and the imposition of end-of-life medical pathways by use of midazolam and morphine. These two things have, no doubt, led to countless deaths during the last year.
The stock piling of 2 years’ worth of midazolam by the UK government in March 2020, as well as the further order from Accord is well documented. A spokesperson from Accord Healthcare, one of five manufacturers of the drug, told The Pharmaceutical Journal that it had to gain regulatory approval to sell French-labelled supplies of midazolam injection to the NHS, after having already sold two years’ worth of stock to UK wholesalers “at the request of the NHS” in March 2020. See here
It is also well documented that this stockpile was low by October 2020 see here and this was reiterated in by February 2021 by an NHS medicine supply notification
Given the above, it is now time for us and our MP’s to have an urgent conversation about where all the midazolam went. The misuse of DNRs is intrinsically linked to this conversation. However, we all need to remember what a DNR actually means, when we are talking about this issue.
For more information about how the elderly in care were denied treatment in hospital during the last year, as well as other issues connected to care homes, see the Amnesty Report, “As If Expendable” here