DNR: everyone deserves dignity

Everyone is entitled to dignity at the end of their life, and to die as they would wish. The way the UK government is managing the coronavirus pandemic is failing to respect that. Watch Brian Parkin’s video below and sign the petition.

Note (added 8 April 2020): please see below for two important clarifications.

The last few days have seen many alarming reports about the use of Do Not Resuscitate (DNR) and similar forms. It is widely reported that people – including elderly residents in care homes and the 1.5 million ‘shielded’ people most at risk from coronavirus – have been told they must simply accept that these forms will be signed for them. Here we share a video from Brian Parkin, aged 70 from Leeds – Brian is seriously ill with cancer, and recently found that DNR has been applied to him, without his agreement.

Brian is calling on people to sign a petition calling for vulnerable people to be treated with respect, and for their wishes at the end of life to be respected – sign it here.

The outrage which has met cases like Brian’s is entirely justified. From the beginning of the pandemic, members of the Johnson government have repeatedly stressed that we need to limit damage to the economy. It’s implicit in these statements that a certain number of deaths is an appropriate price for businesses’ profitability. And it’s clear whose deaths we’re talking about. Number Ten has denied that Dominic Cummings’ views can be summed up in the words “if that means some pensioners die, too bad”. But there’s no denying that on 3 March Jeremy Warner, a columnist in the Telegraph, wrote that “from an entirely disinterested economic perspective, the COVID-19 might even prove mildly beneficial in the long term by disproportionately culling elderly dependents.” Those who aren’t working – the elderly, the chronically sick, disabled people – do nothing to contribute to profitability, and are regarded as expendable.

No wonder, then, if many of the people asked to agree to DNR forms have regarded them as a death warrant – they have seemed like a callous statement that if they do become seriously ill they, the most vulnerable, will be abandoned. Staff in care homes, too, suddenly find that they cannot expect residents to be hospitalised and that they themselves are expected to deliver end-of-life care, for which they have no training. In this way they become a symbol of what is wrong with our society, as exposed by coronavirus – the treatment of those not working, and also of those people who do the difficult and skilled work of caring, often with no recognition and on the minimum wage.

Discussions about how a person wants to be treated at the end of life are difficult ones at the best of times. The choices available to doctors can be limited. People in an intensive care unit can be connected to tubes to help them breathe, feeding tubes, intravenous tubes to provide fluids or medication and tubes to drain blood or urine. It’s a highly invasive and medicalised situation, physically stressful in itself and a person has to be sedated for it to work. Because this kind of treatment is so demanding on patients, it may not be effective in prolonging the life of a person who is already very weak and ill. Patients have to be ventilated to undergo the procedure called CPR or cardiopulmonary resuscitation, where medics press hard on a person’s chest to try to keep blood flowing when the heart has stopped – in many cases this breaks the patient’s ribs. It therefore may not help very frail or elderly people. These are the kind of scenarios that people need to have in mind when they discuss the end of their lives. Even if we had all the doctors and all the ventilators we need, there will be situations where all that can be done for people is to help them die as far as possible with dignity and in accordance with their wishes.

But, of course, we don’t have all the doctors and ventilators we need. We don’t even have protective equipment for medical staff, who are forced to improvise, the BBC reports, using clinical waste bags and skiing goggles. Shortages of NHS staff, and lack of respect and training for care home staff, make it less likely that patients and those close to them will be involved in sensitive discussions about how they would wish to be treated at the end of their lives. The coronavirus has highlighted so many failings in our health and care system, and when the pandemic is over, that must change – we must have proper funding, with respect and training for all staff in facilities of all kinds. And while the pandemic continues, no one should be made to feel the way Brian Parkin does – that, without any discussion of his wishes, he had been abandoned and left to die.

Clarifications (added 8 April 2020)

•   DNR forms, sometimes called DNA-CPR forms, refer to a specific medical intervention, as discussed in the article above. They do not mean do not treat. In English law, patients do not have the right to demand CPR, but they or their next of kin should be consulted. As the video, petition and article above argue – every patient has a right to dignity in the way this consultation happens and in their treatment.
•   The video expresses the strong views of a patient who felt denied meaningful consultation. He makes reference to euthanasia, which is the act of deliberately ending a person’s life to relieve suffering, and is illegal under English law whether it is voluntary (at the person’s request) or not. The denial of medical interventions which could save life such as CPR is not euthanasia. However, the way the UK government has responded to the COVID-19 pandemic is leading to obscene numbers of unnecessary deaths.