As the queen prepares to address the nation on Sunday 5 April, some people are asking a difficult question. Because with the growing scandal around social care amid the coronavirus (Covid-19) pandemic, there’s a huge discrepancy between what’s happening to the royal family and many of our elderly or disabled relatives. It’s called a ‘DNR’ (Do Not Resuscitate).
Coronavirus: DNR notices
As Red and Green Action tweeted:
— ❤️ Red & Green Action 💚 (@redgreenaction) April 5, 2020
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A DNR notice is something medical professionals use. It can be issued with or without a patient’s consent; the latter when the patient is deemed unable to make a decision themselves under the Mental Capacity Act. In short, a DNR is placed on a person when doctors think trying to save a person’s life would be unsuccessful. It also happens when attempts at resuscitation may leave the person more sick or disabled than they originally were; brain-damaged, for example.
For some people, DNRs are controversial. There have been countless cases where families did not know a loved one had a DNR. Moreover, they pose ethical questions about the value of human life in some situations. But since the coronavirus pandemic took hold, DNRs have sparked yet more outrage.
As BBC News reported, one Clinical Commissioning Group (CCG) in Brighton and Hove has written to care homes for elderly people. It stated that:
frail elderly people do not respond to the sort of intensive treatment required for the lung complications of coronavirus…
We may therefore recommend that in the event of coronavirus infection, hospital admission is undesirable.
It also told care homes to:
check they have resuscitation [DNR] orders on every patient
In other words, the CCG seems to be suggesting care home residents who get coronavirus should be left to die. But this story doesn’t appear to be isolated. There have been reports of similar things happening in Wales and Leeds. Moreover, it also seems that increased use of DNRs is not just restricted to elderly people.
Not just elderly people
As the Guardian first reported, a Welsh GP practice sent out a DNR request letter to all coronavirus high-risk patients. It targeted people with “incurable cancer”, “neurological conditions”, and “untreatable heart and lung conditions”. The use of neurological conditions in the letter is of particular concern. This is because official government guidance states that high-risk neurological conditions include:
- Parkinson’s disease.
- Motor neurone disease.
- Multiple sclerosis (MS).
- Learning disabled people.
- Cerebral palsy.
Some people with illnesses such as motor neurone disease will indeed see a worsening of quality of life if doctors attempted resuscitation. There have been court cases in the UK where motor neurone patients have fought for their right to die. But for many, including learning disabled people, their conditions are not immediately life-threatening. So it seems odd at best that doctors would be issuing this advice. But at worst, it seems scandalous that non-life threatening conditions have been merged with terminal ones.
On social media, the cases of people claiming doctors have issued DNRs without patient consent are growing:
Last week my Dad (95) was asked twice by his practice coordinator if he wanted to sign a DNR. He refused and told her why. Within 48 hrs a letter signed by his GP arrived informing him the GP had overruled and signed on Dad's behalf. 48 hrs later Dad is a broken man.Given up.
— Jill Braund (@JillHS23) April 4, 2020
A friends has just phoned me, upset cos her mother's care home had called her to ask her to sign a #DNR if her mother got Covid-19. The care home manager said they were asking everyone.
She doesn't even have the legal right to make medical decisions, just financial ones.
— Lyn Keay (@LynKeay) April 3, 2020
Andrew Cannon highlighted the fact that doctors were placing DNRs on people even when they legally had mental capacity:
Our response to the GP at one of the three services where blanket DNRs have been applied without consultation. You’ll note that some of the people at this particular location have capacity – we have escalated within the CCG and will also share with CQC. pic.twitter.com/HsHY2EVEgI
— Andrew Cannon (@VoyageCEO) April 3, 2020
And as Helen Ashby said:
How dare people think it is okay to decide which lives matter. How bloody dare they!
— Helen Ashby (@HelenAshby72) April 1, 2020
It’s important to note that some of the reasoning behind these DNRs is that the NHS will not cope with many more severely ill people. Much of this is probably due to a decade of government cuts to services and staff. And while at present, this may seem like it’s only isolated cases, the stress it’s already putting on some families is unacceptable.
‘Burdening’ the health service, or classism in action?
Damian Wilson’s daughter is disabled. As he wrote for RTUK:
In the UK, DNR paperwork effectively throws the choice back to the patient, urging them to choose to die rather than risk being a burden to the health service.
Before the pandemic, Wilson decided to take legal control of his daughter’s financial affairs, but not her health ones. Now, because he does not have a say over her health, he is concerned about what will happen to her if she gets sick with coronavirus. As he wrote:
if my daughter contracts Covid-19 and is admitted to hospital, then who will make the decisions needed on her behalf? Legally, we, her parents, have no say about how she will be treated. We may not even be allowed to be with her.
So, it seems Downing Street’s adviser Dominic Cummings alleged comments about ‘letting the old people die’ have taken on another sinister twist. And while we may not know whether the Queen has a DNR notice on her, we can probably make an educated guess she hasn’t. Coronavirus may not discriminate about who it infects. But the UK healthcare system certainly does over who has a right to live or die if they get it.
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