This site is intended for health professionals only

BMA to review DNR orders guidance

The BMA is reviewing its guidance on resuscitating patients when their heart or breathing stops following high profile cases involving do not resuscitate (DNR) orders.

The BMA’s decision follows two high-profile cases involving an 86-year-old woman who staff wanted to resuscitate despite finding a DNR order in her notes and a high-profile court case involving a woman whose family were angry a DNR order was put on her record without her knowledge.

The current BMA guidance on DNR orders – Decisions relating to cardiopulmonary resuscitation – was established in October in partnership with the Royal College of Nursing and the Resuscitation Council (UK). The BMA said it could not give details about which specific areas of its current guidance it is reviewing.

Ms Jean Robson, an 86 year-old woman with dementia, died in February 2010 while her daughter was arguing about with two nurses who wanted to resuscitate her. Ms Robson’s family highlighted a lack of communication between the hospital and the care home.

Another case involved Ms Janet Tracey, who died at Addenbrooke’s Hospital in Cambridge in 2011. The family were angry that a DNR notice was put on her record without her knowledge or the family being consulted, and took legal action to try to force the government to introduce such consultations. A High Court judge ruled against the family, however.

A spokesperson for the BMA said: ‘This is a complex area of medicine that can be very distressing for patient and people emotionally close to them. While the BMA does not comment on individual cases we will be interested to hear what the Department of Health and the Care Quality Commission say about the Jean Robson case.’

The current version of the BMA guidance states that the overall clinical responsibility for decisions about CPR, including DNR decisions, rests with ‘the most senior clinician in charge’ as defined by local policy. This could be a GP, consultant or nurse.

If patients decide that they do not wish for CPR to be attempted this should be ‘documented carefully in the hospital, GP or health establishment’s records’.