DNR and the abuse of power

With further cases of Do Not Resuscitate notices being given to patients without consent, Ian Macrae says it’s time to question whether this should continue to be an option for doctors.

This week DNR (Do Not Resuscitate) has once again reared its ugly and unwanted head.

A hospital in Margate was forced to apologise to the family of a man with Downs Syndrome when a whistle-blowing nurse told them of the presence of such an order on a relative’s medical notes.

What’s more, doctors in the case of Andrew Waters made the arbitrary and unilateral decision twice.

On each occasion they plainly gave both Downs Syndrome and Mr Waters’ learning difficulties as reasons in support of the DNR decision.

Much was made in coverage of the fact that doctors had not consulted Mr Waters’ family. But as fellow disabled people, our concern must also be for the patient – Mr Waters was also not consulted – and for his human rights.

Obvious though they may be, the reasons why DNR decisions made in this way are wrong cannot be stated too often.

The doctor/patient relationship has many dimensions of which a central one is power and the power is all too often vested in or rests with the doctor. They hold the power of diagnosis, albeit exercised in an informed way. They have the power to give, sometimes to enforce, treatment. And with DNR they hold power over whether someone lives or dies.

In so many of the cases we’ve heard about over the years, including the often quoted one involving Jane, now Baroness Campbell, DNR is invoked because the person with power, the doctor, has made a decision based on their view of the value and worth of the disabled life over which they hold judgement. In the case of Andrew Waters the calculation placed his life as being of so little value because he had Downs and learning difficulties as to be not worth saving.

Even if you ignore the fact that a patient may temporarily or permanently lack the capacity to engage in a discussion, the fact remains that a doctor should simply never feel that they have the right and power of life and death over someone, based purely on their own subjective view of the value of that person’s life. And surely it is time that any code of conduct or medical ethics laid down include strict protocols governing the placement of DNR on someone’s notes. Indeed, maybe it’s time to go further and demand that this practice be deemed unethical and put beyond use.

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