Responding to recent developments

Supporting doctors after recent court judgements

Recent court cases have highlighted the complexities surrounding DNACPR decisions.

The Tracey v Cambridge University Hospitals NHSFT [2014] and Winspear v City Hospitals Sunderland NHSFT [2015] court judgements emphasised that DNACPR decisions must involve discussion with patients where they have capacity (unless such discussion is likely to cause physical or psychological harm); and discussion with a patient’s carer where the patient lacks capacity (and it is practical and appropriate to do so). These requirements apply to anticipatory decisions about CPR which are made on the grounds that CPR will not succeed in preventing the patient’s death, as well as decisions made on the balance of benefits, burdens and risks for the patient.

The BMA, Royal College of Nursing and Resuscitation Council UK published updated decision making in 2014 in response to the Tracey case (which we supported). They are working on further revisions in light of the Winspear judgement, again with our support, and these should be available soon.

We are also developing new supporting materials to help doctors with the practical challenges around effective communication with patients and their carers about DNACPR decisions. These resources are being created in partnership with organisations who have specific expertise around end of life care including the National Council for Palliative Care and the Gold Standards Framework Centre. They will be published on this part of our website during the first half of 2016.

Consultation on emergency treatment planning

In future, doctors in England could be using a new approach to emergency treatment planning – supported by a new form – to change the way they plan ahead with patients to deliver care that meets their individual needs. The aim is to move the focus from making a specific DNACPR order to ensuring that CPR decisions are just one part of a broader plan for managing a patient’s anticipated emergency care needs.

The new Emergency Care and Treatment Plan (ECTP) was developed by a working group led by the Royal College of Nursing and the Resuscitation Council UK. A public consultation on the draft ECTP closed on 29 February 2016. You can find the  on the Resuscitation Council’s website.

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