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My uncle is currently in hospital and the doctors asked my sister whether he would want to be resuscitated if the need arose.
It got me thinking.... Not sure I want to be resuscitated.
Had a good life.
Given most cpr attempts are not successful and it's a harrowing experience for those giving it until an ambulance arrives.
Add to that the high potential for brain damage.
Is a DNR tattoo recognised by the doctors as an instruction to leave it be?
Is bumping still necessary? Really?
Is bumping still necessary? Really?
No
DNR Tattoos are pointless they’re have no legality about them, but neither does an official DNR.
but neither does an official DNR.
You sure on that Drac? ( I would assume you are) or is Scots law differnt? You cannot force someone with capacity to have treatment against their will which is what attempting CPR woulkd be. Defense would be that you did not know but it would be common assault to CPR someone who refused it
100% positive.
DNR Tattoos are pointless they’re have no legality about them
What is the actual law regarding DNRs?
You read a lot about older people having them applied without even being asked - seems a very unregulated area.
In re T (Adult: Refusal of Treatment): CA 1992
A patient’s right to veto medical treatment is absolute: ‘This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.’ However the capacity must be commensurate with the gravity of the decision purported to be made: ‘The more serious the decision, the greater the capacity required.’
References: [1992] 4 All ER 649, [1992] 3 WLR 782, [1993] Fam 95
Judges: Lord Donaldson of Lymington MR
One of the key bits of law. On this along with sidaway (IIRc) which makes it utterly clear that treatment without consent is against the law.
Are you really saying you can attempt CPR if a DNACPR is in place and you are aware of it?
Whats the legal basis for this as it flies in the face of numerous legal precedents, what i was taught by a legal professer at Uni and what i have been told my entire career
As a first aider, if I came across someone requiring CPR, I'd be completely ignoring the details of any tatts tbh.
DNACPR is a very regulated area. Its a decision for the medical team but MUST be discussed with the patient or the patients legal guardian and their wishes taken into account
to apply one in the face of someones wishes you have to have a very strong medical case and it really should not happen
Drac is right. Living will is legally binding
https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/
Drac is saying they are not binding - DNACPR orders
Living wills are a bit different
But it is a basic principle of medicine that yo cannot treat without consent if the person has capacity
DNACPR is a very regulated area. Its a decision for the medical team but MUST be discussed with the patient or the patients legal guardian and their wishes taken into account
Are you really saying you can attempt CPR if a DNACPR is in place and you are aware of it?
Yes. Emergency medicine is different, you act in the patients best interest, an unconscious patient can’t give consent. A DNR does not have to be followed I am not making this up. People change their minds, DNARs can be written up and not revoked at a time patient may not have survived a resuscitation. The may now be able to survive without any consequences. The patient may not have been the one who agreed to it, living will may have and now changed their mind. Are you telling me you’d not resuscitate a patient because the living will has changed their mind?
https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/
Ok well you re the emergency medicine expert and of course if they are unconcious they cannot consent
But I do not see how you can do CPR on a conscious non consenting person with capacity.
Got any legal precedent / guidance on that? It goes against everything I have been taught on this
Scots law around capacity and consent is different to English but only in minor ways
DNACPR HAS to be agreed with the patient of their POA
the legal precedent is clear to me - if they have signed a DNACPR then any attempt at CPR is assult
In an =emergancy and its unclear of course you do CPR - but if there is clear refusal of consent?
Because my dad had had double heart bypass surgery a nurse persuaded him to get a DNR. My mum decided she would have one two (she had lymphoma).
And 5 years and one day ago she collapsed in the bathroom and my dad called an ambulance. Paramedic showed up and started CPR and my dad had to go, ‘hold on, she’s one of these...’ and produced the signed DNR thang. Paramedic stopped and my mum never made it to hospital.
In Scotland.
Footflaps - and they were behaving illegally in doing so.
OK Drac - read your link. Intersting. I wonder if anyone has tested that in court?
Scots law around capacity and consent is different to English but only in minor ways
They’re also not legally binding in Scotland.
Reading furether down your link Drac it seems to contradict.
Refusing CPR in advance
Everyone has the right to refuse CPR if they wish. You can make it clear to your medical team that you do not want to have CPR if you stop breathing or your heart stops beating.
This is known as a do not attempt cardiopulmonary resuscitation (DNACPR) decision, or DNACPR order.
Once a DNACPR decision is made, it's put in your medical records, usually on a form that health professionals will recognise.
I guess its a wee bit of a gray area in that it is not legally binding but if you go against a DNACPR order you would be answerable in court as to why you did this in a defense against an assault charge
Everytime I have seen on in recent years its also been accompanied by an "advance care plan / directive
That doesn’t contradict it at all, that just explains what one is. It doesn’t say they must follow it. If they’re part of an Advanced Healthcare Plan then that is different, as AHP are binding.
I find this utterly astonishing - what circumstance would you go against a DNACPR? What would your defense be against assault?
I am not saying you are wrong BTW
It’s not assault.
A family member agreed to it and now changed their mind. It was written in hospital while recovering from a serious illness or injury where they’d not have survived but now would.
Anyway tattoos are a stupid idea.
It most certainly is assault to do any medical treatment without consent on someone with capacity NO question at all. That is 100% certain. You can have a defense of good faith but there is no doubt its assult.
If they have changed their mind then the DNACPR is no longer valid - of course.
DNR tattoos are a stupid idea I agree
I’m tired, I’ve worked 12 hours with no break and had a shit job. I can’t be bothered so I’ll bid you goodnight.
My uncle is currently in hospital and the doctors asked my sister whether he would want to be resuscitated if the need arose.
It got me thinking…. Not sure I want to be resuscitated.
Had a good life.
I guess it depends why you are likely to need resus and what your quality of life / expectation is afterwards. If its buying you days stuck in a hospital bed I'm with you; if its buying you weeks to say some goodbye's perhaps not so bad (if not for you then those who will miss you); if its years of being cared for by others and never leaving your house - that doesn't appeal much to me; but it could be 20+ years of a "normal" life with perhaps a few meds...
Given most cpr attempts are not successful and it’s a harrowing experience for those giving it until an ambulance arrives.
I think it would be pretty harrowing watching you die in front of me, and not being able to do anything because a tattoo said to stop.
Add to that the high potential for brain damage.
your risk of braindamage could be worse - what if "I" don't start CPR because of your Tat, but Drac turns up 4 minutes later and says "a tattoo isn't legally binding - we should try anyway" - that's worse than me having started as soon as I could. Prospects of brain damage and of survival are very different in different circumstances. Traumatic arrest in the middle of nowhere following a big crash with nobody around to see it happen and start help straight away and then a long delay before equipment arrives is very different from in hospital getting some illness investigated and has a sudden arrest where monitors immediately alert experienced staff and specialists and equipment are with you almost instantly. Then in the middle you have the possibility, perhaps the most likely for people of "our" age with no known major medical conditions - of suffering a heart attack which doesn't result in immediate arrest, and first responders arriving with (or quickly able to get) a defib potentially there whilst you still have a pulse but are on a slippery slope... or fairly soon after but "amaturer" CPR happening within seconds of the arrest.
Is a DNR tattoo recognised by the doctors as an instruction to leave it be?
Even if it was - I'd probably have been jumping up and down on your chest for sometime before someone was removing clothing to attach pads and saw your tat (if it was anywhere other than your chest I doubt they'd see it until the post mortem!).
I am sorry you have had a shit day Drac but the law is clear. a competent person cannot be given medical treatment against their wishes ( except in the very rare case of an infectious disease carrier)
any attempt to do so would be assault.
Lots of case law around this
An irrational decision is not necessarily incompetent
the key test is do they understand the consequences of their action - if they do then their wishes are paramount
Its been tested in the courts. the right to refuse treatment is absolute ( except if carriers of infectious disease)
touching without consent is assault. therefore medical treatment against the wishes of someone who refuses consent is assault
"An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo … The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative … The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.”
The principle of informed consent has been established from the recognition that every individual has the right to decide what treatment they wish to receive and the right to refuse treatment even in cases where the treatment might be essential to the preservation of their life. According to an article published by the Department of Health in 1990 patient’s have the right to refuse treatment or withdraw previously give consent. In the paper the DOH commented that
“Subject to certain exceptions the doctor or health professional and/or health authority may face an action for damages if a patient is examined or treated without consent”[5]
https://www.lawteacher.net/free-law-essays/medical-law/bolam-test-clinical-negligence.php
From resus.org.uk
What is the difference between a DNACPR decision and an ‘Advance decision to refuse treatment’ (ADRT)?
A DNACPR decision is made and recorded to guide the decisions and actions of those present should the person suffer cardiac arrest, but is not a legally binding document.
An Advance Decision to Refuse Treatment (ADRT) is (as defined in the Mental Capacity Act 2005 – England & Wales) a legally binding document that the person has drawn up (when they had the capacity to make decisions) and in which they have stipulated certain treatments that they would not wish to receive, and the circumstances in which those decisions would apply. Where a properly drawn-up ADRT refuses CPR (despite acknowledging that their life would be at risk) a healthcare professional who attempts CPR on that person in full knowledge of the valid ADRT would be at risk of a charge of battery.
My bold. Seems pretty straightforward.
"Oh my god, my dad is having a heart attack! Can anyone help?!"
"Sure, I'm fully trained and can likely save his life. But first, have you got his paperwork?"
It's a strange one is this. The 'right to refuse treatment' that TJ is posing feels to me more like a right to go "no thank you, I don't want Paracetamol or a blood transfusion." A DNR agreement on the other hand seems more like... something someone already near end of life would undertake, and they probably aren't the first people to be running to tattoo studios getting IWANT2DIE painted across their knuckles.
Back in my 20s I had a pact with a good friend around this, neither of us wanted to be cabbaged and we agreed to speak up for each other. A quarter of a century later both of our circumstances have changed radically and repeatedly. He's formerly absolved me of that decision years ago in favour of it now being his partner's call. So, about that tattoo?
The key I think is in monkeyboy's post there: "in full knowledge". A first responder shouldn't be worrying about, or have to worry about, 'preferences' in a life-or-death situation where literally every second counts. Someone who's been in a hospital bed for two years waiting for the inevitable is a wholly different prospect.
An otherwise fit and healthy individual wanting a DNR tattoo is probably better served with counselling rather than ink.
Precisely GreatApe.
The ‘right to refuse treatment’ that TJ is posing feels to me more like a right to go “no thank you, I don’t want Paracetamol or a blood transfusion.”
NOpe its absolute. Refuse treatment when you have capacity then that is absolute. any treatment is illegal. If you are competent as defined in law a doctor cannot over ride your wishes even if your refusal to take treatment appears irrational and will cause you to die. The only test is "! Are you able to understand the consequences of your decision"
There is a disconnect here I am going to have to look into further.
In an emergency you have to do what you think is best - "Bolam" is the legal test IIRC which is effectively " have you followed a course of action that would seem reasonable to the medical profession at large" so if you do not know a DNACPR is in place and you perform CPR then you have a defense
there is also the " doctrine of necessity" which allows a medical professional to take action where you do not have the ability to ascertain the patients wishes and there is no time to do so. Again "Bolam" is the test
But when the persons wishes are clear IE they have a recent DNACPR that is valid then to perform CPR would be clearly against their consent and if the medical practitioner knew this then to perform CPR would clearly go against the principles of bodily autonomy
Drac refferd to someone changing their mind on a DNACPR - clearly in that case the DNACPR is no longer valid - it has been revoked. I guess Dracs point is that in that situation the DNACPR form while still in existence is no longer valid and thus can be ignored
There is also "Gillick competence" which defines a competent decision ( building on earlier case law)
Note Scots law and English law have some significant differences around capacity and consent
So while a DNACPR may only have the legal status of "guidance" if you go against that guidance you would be in a position of having to explain to a court why you violated that persons bodily autonomy - using one of the defenses above. ( there may be others) So not automatically illegal in that its not strict liability - you have a defense but it wold be up to the practicioner to show that their reasons for violating bodily autonomy were legal
Presumably its this disconnect that makes it practice that all DNACPR decisions I have seen in the last decade or more are accompanied by an "Advanced care plan" to make it legally binding. I have not seen one done without the other for a long time.
I guess the other aspect is that DNACPR decisions can me made without the persons consent ACPs ( as they are called in Scotland) cannot
Very interesting and takes you into some deep ethical and moral areas and brings to the fore a conflict in the law.
Hmmmmmmmmmm I am off to get serious advice on this and to read into this further
So the DNACPR legally is the doctors decision thus may not necessarily be reflective of the patients decision thus going against the DNACPR order is not necessarily going against bodily autonomy
whereas acp or adrt is the patients decision
Is that the key point?
Every day is a school day
145
A DNACPR decision should not override your clinical judgement about CPR if the patient experiences cardiac or respiratory arrest from a reversible cause, such as the induction of anaesthesia during a planned procedure, or if the circumstances of the arrest are not those envisaged when the DNACPR decision was made.
Emergencies and CPR
146Emergencies can arise when there is no time to make a proper assessment of the patient’s condition and the likely outcome of CPR; when no previous DNACPR decision is in place; and when it is not possible to find out the patient’s views. In these circumstances, CPR should be attempted, unless you are certain you have sufficient information about the patient to judge that it will not be successful.
almost all the discussion I can find is around the position where a patient wants CPR and the medical team think it futile not the other way round
whereas acp or adrt is the patients decision
Is that the key point?
Sort of, not that simple but yes.
Anyway time to get ready for work.
Ta Drac.
Have a good day at work and may your medico-legal and ethical dilemmas be few 🙂
Legalities aside, where would this tattoo be placed? Large Gothic font on the neck perhaps?
If I witnessed someone who had collapsed, and thought they needed CPR, I'm pretty sure removing clothing to look for a tattoo would be a long way down my list of things to do.
Large Gothic font
Comic sans surely?
Tattoo should be across the forehead so it’s easy to see and laugh at
My uncle is in a semi-amateur band called DNR. Often ponder what the outcome of a medical emergency would be if he was wearing some of their merch at the time. 😁
In Scotland it would be GNR anyway, ‘gonnae no resuscitate’
Which could be bad for any guns n roses fans.
Which could be bad for any guns n roses fans.
Surely they’re all well into DNR age territory anyway?
OOohhhhh - ageist greatape! Not allowed to make DNACPR decisions on basis of age 🙂
Why would anyone want a tattoo of some pedeals on thier forehead ?
IGMC
If I witnessed someone who had collapsed, and thought they needed CPR, I’m pretty sure removing clothing to look for a tattoo would be a long way down my list of things to do.
Exactly my thoughts.
Medical bracelets are a thing though, are they not? Drac, would you check for those?
They are. Not really no, not unless it catches my eye and the patient was stable.
OOohhhhh – ageist greatape! Not allowed to make DNACPR decisions on basis of age 🙂
Sure, but on basis of bad taste?
( 😉 obviously, I have them on my playlist )