DNAR Decision-Making in 2020

Find out about our work on DNAR decision-mkaing in 2020 and beyond. Our research has centred the experience and rights of people and staff, and helped to inform the work of the Care Quality Commission on this issue. Our research has been reported in the UK press, informing national conversations on this issue - see the end of this page.

What is a DNAR?

A Do Not Attempt Cardiopulmonary Resuscitation Order (DNACPR / DNR / DNAR) is when medical professionals decide to not provide CPR (cardiopulmonary resuscitation). CPR can be a life-saving treatment, depending on the situation; but it is also an invasive treatment and is not always successful. DNAR decisions are medical decisions. Often, these decisions will take place as part of advance care planning to allow people to decide that they do not want CPR in certain situations. It can also be discussed with people as part of their treatment plan, where medics do not think CPR would be beneficial, for example because someone is at the end of their life.

DNARs and people's human rights

When DNAR orders are made with the full involvement of a person, as part of advanced care planning or a treatment plan, this can be an example of good human rights practice. The use of DNARs orders without involving the person and/or their loved ones raises a number of human rights issues including: the right to life, the right to be free from inhuman and degrading treatment, the right to family and private life and the right to be free from discrimination, all of which must be respected and protected by health services under the Human Rights Act.

Highlighted during Covid-19 but a long-term issue

Each year people who draw on health and care services, advocates and frontline staff, share their concerns with us about DNARs being used a discriminatory or other improper ways. Since the start of Covid-19 pandemic in the UK (March 2020), there has been increasing concern about the use of DNAR orders being made without involving people, and that they are being made for discriminatory reasons, including because of people's age or because they are disabled (or both). Read our Director's blog "The fight against Covid-19: Whose Life Counts?" from 2 April 2020. You can read more about the media coverage of issues we've raised on this at the end of this webpage. Through our direct work with over 2000 people during the pandemic, it became clear that DNAR decisions were continuing and a spotlight has been shone on this worrying, and often unlawful, practice. Our summer research showed (click on each image for the related research report)

      

The CQC DNAR Review and BIHR's work

We shared our research with the regulator in England, the Care Quality Commission. The CQC is conducting a rapid review of DNAR decisions during Covid-19 between November 2020 and March 2021 (CQC Press Release). We are a member of the CQC Expert Reference Group, sharing our concerns about the use of DNARs. To coincide with the Review, we have undertaken a programme of work to produce experience-led research on the use of DNARs with people drawing on services and those who care about them, advocates and staff in health, care and social work services. We have:

Research Workshops and surveys

Together with Learning Disability England and Turning point, we've hosted information and research workshops with people who have experienced DNAR decisions and their advocates, and staff working in health, care and social work who have seen the use of DNAR which they are concerned about. We also hosted open access, Easy Read, surveys with the same research questions to combine our findings. We research over 120 people directly in the research (although many shared the experiences of their groups, networks and colleagues), our staff workshop in particular was hugely over-subscribed, with a large waiting list. 

Our Reports

We have produced reports based on each workshop, publishing them after each session and prior to the CQC's final report. The Reports have been shared with the participants, the CQC and publicly. Both reports are also available in Easy Read versions:

People's experiences of DNARs when accessing health and social care: 

       

Staff experiences of DNARs when delivering health and care:  

     

 

Blogs and media commentary on our work

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Author: Josephine Whitehouse

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