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'Do not resuscitate' orders face Court of Appeal verdict

The use of controversial 'do not attempt resuscitation' (DNAR) medical directives is to face the scrutiny of the justices at the Court of Appeal, after a case was brought by the family of a lung cancer sufferer, who died in hospital in Cambridge three years ago, reports the BBC.

Janet Tracey was suffering from incurable lung cancer, and died as an inpatient at the Addenbrooke's Hospital in Cambridge in March 2011. She was in hospital after being involved in a serious car crash, suffering from injuries unrelated to her cancer.

Mrs Tracey, from Ware in Hertfordshire, was subjected to a DNAR order, which effectively bars medical professionals from attempting cardio-pulmonary resuscitation (CPR) if a patient who is subject to such an order goes into cardiac arrest.

The family of Mrs Tracey are pursuing a civil action against Cambridge University Hospitals NHS Foundation Trust, seeking a review of how the DNAR forms are issued by medical professionals, with a view to seeing a national policy implemented covering their use.

Do Not Attempt Resuscitation

DNAR orders are advanced care directives issued by medical professionals concerning the use of CPR for the treatment of cardiac arrest.

DNARs can be issued in hospital or in the community, and effectively state that if the heart of the patient stops beating, aggressive CPR techniques are not to be used to attempt to restart the patient's heart.

CPR techniques include chest compressions required to manually maintain perfusion of tissues when a heart has stopped beating, the administration of electric shocks in an attempt to restart a normal cardiac rhythm, and the administration of drugs.

Only one in five of all patients who receive CPR techniques in hospital survive to discharge. This number is much lower for patients with other medical problems.

Medical decision

The issuing of DNAR forms is primarily a medical decision, based on the doctor's view of whether CPR is likely to be successful. Existing guidelines require doctors to consider each patient's circumstances individually, to communicate with patients and their families where it is appropriate to do so, to involve patients in decision making, and to review decisions regularly to take into account changes in circumstances.

Mrs Tracey's family were dismayed when a DNAR was placed on their relative, and complained such that the DNAR was rescinded. It was subsequently reinstated three days later without consultation with the family, and Mrs Tracey died two days after that. CPR was not attempted.

Kate Masters is Mrs Tracey's daughter.

"The situation really has to change so that no other families are left like mine are. How someone's end of life is handled really does live with the family forever," she said.

At present every NHS Trust in England implements a different policy on DNAR. Individual doctors often avoid discussing the matter with patients and families for fear of upsetting them, particularly when an arrest scenario is unforeseen.

The High Court has already ruled that doctors at Addenbrooke's acted appropriately with regards to Mrs Tracey's care.

There is currently no centrally collected data on the use of DNAR in hospitals.