Blogs Coffee House

DNR notices: A matter of life and death

18 June 2014

It was Janet Tracey’s family who brought about a change in the law regarding Do Not Resuscitate notices on patient’s notes in hospital. Thanks to their efforts, hospitals will now have to consult patients and their families before instructing medics that they shouldn’t go out of their way to provide life-saving treatment. Mrs Tracey had made perfectly clear that she wanted to be in on her own case; didn’t matter – she got a DNR notice anyway.

I’m not sure whether I was in quite this situation a couple of years ago when my mother was in St Mary’s Paddington after a fall. She succumbed to an infection which she may have contracted before coming to the hospital: don’t know. But when it was clear that her condition was deteriorating, it was I who brought it to the attention of the medics. At one point, a young female doctor told me that if it came to the worst, they wouldn’t be resuscitating; she just wanted to let me know. I was so thoroughly demoralised and am anyway so inclined to assume doctors are both omniscient and benevolent, like God, I said:  ‘whatever you think best’. It was only later that night when things were looking bad that a young male doctor came to put the same question. ‘I was told we shouldn’t resuscitate,’ I told him feebly. ‘Yes, but you’ve only got one mother, haven’t you?’ he said. It felt like a weight lifting from me. ‘Yes,’ I said. ‘Just do whatever it takes.’ She recovered. I’ve prayed for that young doctor ever since.


Now what struck me then and now about the situation, and indeed about Mrs Tracey’s, is that there is a terrifying divide in treatment of the elderly between those who have family to fight their corner and those who don’t. Had my mother been childless and alone, I’m not at all sure what would have happened.

It’s the same when you get those horror stories about the abuse of the elderly or mentally infirm in care homes by people who are meant to be looking after the residents or inmates; if you don’t have the luck to have an undercover Panorama reporter on the premises or a family ruthless enough to install a camera in your room, then you’re toast if you happen to be minded by the cruel or uncaring. You’re at the mercy of the system as supervised by the Care Quality Commission. What we need for the frail elderly is a system of supervision and care, in hospitals or homes, which is as compassionate when it comes to those who don’t have relations who care about them as those who do. In terms of care homes, CCTV cameras, with unscripted inspections, should be the minimum norm – and criminal prosecutions, not warnings or sackings, for those who abuse the frail and old. When it comes to hospitals, it seems right, if a little overdue, that patients should be consulted about their own life and death.

More Spectator for less. Subscribe and receive 12 issues delivered for just £12, with full web and app access. Join us now.

  • Retired Nurse

    According to Dr Simon Bennett: “On 16 May 1966 the Physician Superintendent at London’s Neasden Hospital
    issued the following Memorandum: “Respiratory Failure and Cardiac
    Arrest Resuscitation …. The following patients are NOT
    [sic] to be resuscitated:- Very elderly, over 65 years; Malignant
    disease; Chronic chest disease; Chronic renal disease; Top of yellow
    Treatment Card to be marked – N.T.B.R. (i.e. Not to be resuscitated)”.
    The instruction was followed for sixteen months … until on 20 September
    1967 the BBC made it public. (I cannot think of a better justification
    for ensuring the British Press remains immune from political meddling).
    The Minister for Health ordered that the instruction be withdrawn. Some
    doctors regretted only that the instruction had been committed to paper.
    They would have continued using Neasden’s NTBR protocol.”

    Fairly obvious some never stopped ….

  • Retired Nurse

    They use a code you dont even know about – and are still using it at the Royal Bournemouth and Christchurch NHS FT – they write ‘no 2222′ on the records of anyone with a dementia diagnosis or over 70.This case….was only admitted with a tummy bug…

    2222 is the dedicated switchboard number for the resus team, so its fairly obvious what ‘no 2222′ means.

    CQC write a report….hospital (who employ a full time press officer ) spin it on their website, and nothing changes at all.
    The NHS really hates the elderly.

  • JoeDM

    When my mother-in-law was dying in hospital a couple of years ago, we were told that the policy was that they would resusitate three times and if there was no real improvement in her condition then they would not resusitate a fourth time unless it was just to allow family time to get to her bedside.

    Seems to me to be a reasonable way to manage terminal illness and family expectations.

  • Alexsandr

    surely not resuscitating without the patients or attorneys consent is murder. Certainly goes against what the medics are supposed to be for.

    as for care homes. I had a relative in a care home and they were great. OK some care homes will be bad but lets remember many will be good. We just dont hear about it in the news.

  • Mark McIntyre

    In an overpopulated country in an overpopulated world – DNR for all patients over the age of seventy should be the standard.
    Thanks to the ‘blessed’ NHS more people than ever are living into old age – to an age beyond their ‘shelf life’ – resulting in ever more people ending up in ‘care’ on account of the failure of their body or mind to ‘last the course’.
    The burden they are placing upon this country will only serve to bankrupt this country and alienate them from those who come after them AND have to pay for them.
    These old aged decrepits may well have paid all their NI subs, BUT, the odds are they will have used up all such payments.
    No one has the right to live forever – no one has even the right to expect to live forever.
    Ergo – death comes to us all – get used to it, get over it, and while you still have one – get a life !

    • telemachus

      What an appalling ageist post
      Most people I know who live beyond 70 are fit agile and mentally alert
      Most between 70 and 80 deliver net benefit to society, not least by providing childcare for their children eking out a living working long hours on low wages
      I think you would do best to edit your post

      • sir_graphus

        Tele, old chap, you may bask in the approval of we Spectator readers for once in your life. Enjoy it.

      • Mark McIntyre

        tele – are there no depths to which you will not plunge ? – in order to attain the approbation of your peers !

    • alabenn

      And hopefully you will either get a deadly disease or get to be a fit seventy, then see if your argument holds water with your self then.
      It is not only old people they are putting to death with their careless unthinking mantra.
      The NHS is itself a deadly disease.

    • Tom M

      Well Mark that post has the beginnings of a government policy around in certain quarters in the 1930s.

      • Mark McIntyre

        Wishing tha could have voted for it !

    • JB_1966

      And Mark McIntyre – fuck him he can just be left on a trolley.

      • Aberrant_Apostrophe

        That would be Mark ‘DNR me when I get to 70′ McIntyre, aged 14½

        • Mark McIntyre

          No, it be M’DNR’MI of middle middle age !

    • Alexsandr

      You really are vile aren’t you?

    • Retired Nurse

      sounds like he’d advocate Hitler’s ‘Hungerhausen’ policy…he started off with the elderly too..

Can't find your Web ID? Click here