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Care homes: no recovery from ‘Do Not Recover’ orders?

Care homes: no recovery from ‘Do Not Recover’ orders?

MPs are calling for a review of ‘Do Not Attempt Resuscitation’ orders for care home residents, ‘as fears grow that blanket decisions are still being taken’; during the first wave of the Covid pandemic, it emerged that some homes had placed such orders ‘on every single resident’, and the Care Quality Commission was tasked with looking into the situation, but MPs fear that such ‘“blanket orders” imposed months ago could send thousands to their deaths in coming months.’ In a letter, 16 MPs, ‘including the chairmen of the all-party parliamentary groups on coronavirus, on ageing and older people, and on rural health and social care’, have called on the Health Secretary to order ‘an urgent review of every DNAR placed on file’, saying ‘they were “incredibly disturbed” by reports of “clearly unlawful and unethical policies’; although the CQC review ‘was welcome’, its findings ‘may come too late’, since ‘“[a]n unknown number of DNARs remain in care home residents’ files. Many of those people could get ill over the winter – they cannot wait for the outcomes of the CQC review and neither should they need to”’.


Amnesty International has backed their calls, with its UK director, Kate Allen, saying that ‘the unlawful use of the orders for care home residents was a “clear violation of human rights”.’ A Department of Health and Social Care spokesman responded that the blanket use of such instructions ‘“has never been policy and we have taken action to prevent this”’, saying that it was ‘“completely unacceptable” for “DNAR policies to be applied in a blanket fashion to any group of people”’ (‘Care homes still making “no recovery” orders, MPs fear’, Telegraph, November 23, 2020).


It is good to know that it is not Government policy to decide in advance that large numbers of vulnerable old people are not worth saving; however, it is Government policy to exempt from Covid restrictions those individuals going to Switzerland to end their lives. As with individuals who complete DNARs, they would no doubt see this as a matter of individual choice; however, if the alternative is lack of support in the one case, and Covid isolation in the other, ‘choice’ becomes a meaningless concept.


Giving vulnerable people the ‘choice’ to end their lives is simply saying ‘we don’t care if you die, as long as it’s your (nominal) choice’. But whether it is accomplished by not treating/caring for the person, or by lethal injection/deadly cocktail, to not care if a person dies is to not care about that person.


‘Do Not Resuscitate’ orders may seem a sensible approach, but it simply means asking people to decide that they do not want to be treated in future circumstances that cannot be known without the help of a crystal ball; the case of the elderly Dutch lady with dementia who, when in good health had signed a form saying she would want euthanasia if she lost her faculties, and was forcibly euthanized by a doctor despite striving to avoid the lethal injection, demonstrates the dangers of signing your own death warrant in advance.


It would be far better and more ethical to leave decisions about resuscitation to the clinical judgement of medical professionals, but if that judgement has been undermined and possibly corrupted by the elevation of ‘choice’ above ethics, who will trust the word of the doctor?


Choosing to do a wrong thing does not make it right simply because we choose to do it; and at the root of the ‘right to die’ approach is the subjective view - either of other people or of the future self we fear becoming - that we would hate to ‘live like that’ - that death would be preferable; hence, whoever is ‘living like that’ must want to be dead.  Making an idol of faux choice has led to the mania for blanket DNARs; sadly, it appears that many care homes have not recovered from their earlier bout of Covid ‘Do Not Recover’ orders.