Hospitals slap do-not-resuscitate orders on patients without consent

Life-ending orders continue to be slapped on unsuspecting hospital patients who doctors think should be left to die.

Patients are having do-not-resuscitate orders placed on them without their consent or that of their family.

Stuff understands there has been one such case in recent weeks at Palmerston North Hospital, where a patient had an order placed on them without their family's knowledge.

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The family did not want to publicly discuss the issue, but were shocked to discover what happened.

MidCentral District Health Board did not respond to questions about the incident.

The same thing happened to Tim Wallace's mother Juanita at the same hospital in 2010.

"I asked to see her file to see what she was on and they brought out the folder and in the front of it there was a thing they call a 'green sheet'. As I found out later, the ED doctor had put a non-resuscitation order on her."

She died about three years after that admission to hospital.

Wallace had power of attorney for his mother and knew she was not interested in such an order.

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"I did some investigating and found [the practice] was common place in hospitals throughout New Zealand.

"As far as I'm aware it still is."

Wallace said he understood more about the issue now and appreciated the impact on staff.

"They are the ones that have to go through the exercise of resuscitating someone... so I can see the practical side.

"But I can also see the lack of concern for that person who is entitled to their life, you would think."

Massey University School of Nursing professor Dr Jenny Carryer said resuscitation was not a black and white issue.

"Sometimes, the topic has never been raised by the patient, staff or family, yet the person may suddenly deteriorate and the people caring for them know it would not provide a good outcome for them."

Ideally, the issue should be discussed with patients and their family, she said.

"[However,] like all things in health, it is a very nuanced situation.

"Human situations change quickly. They are complex, they are challenging, people change their minds. It is never simple and straightforward."

Carryer was not aware of legal obligations requiring hospitals to inform families about the orders, but said it was "not good practice" to leave them in the dark.

Carryer said resuscitation orders were not always appropriate for patients who didn't have long to live anyway.

Even for some non-terminal patients, a resuscitation attempt would "almost certainly" leave them in an even worse position.

Euthanasia-Free NZ executive officer Renee Joubert said the default response should be that a person is to be resuscitated, unless they have explicitly refused it, while mentally competent.

"We have a duty of care to each other.

"We are very concerned about the many stories we have heard about disabled people discovering a do-not-resuscitate order on their file without their consent, and about some doctors' unwillingness to resuscitate disabled people, simply because they are disabled."

The Health and Disability Commissioner's stance on the issue is that it is the responsibility of the doctor to decide what to do in cases where a patient is already incompetent, but has not made  decision to refuse future CPR.

It notes that the views of family members are not binding.

 - Stuff


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