Liverpool Care Pathway – Giving Killing An Acceptable Face

Elderly patients condemned to early death by secret use of do not resuscitate orders

A report in the Telegraph is particularly disturbing.

DNR orders are routinely being applied without the knowledge of the patient or their relatives.

At Royal Shrewsbury Hospital, run by Shrewsbury and Telford Hospital trust, a patient was labelled as DNR based on old medical notes from a previous admission – despite the fact their health had improved.

Hospitals are not supposed to put the documents in any patients' files until they have been filled in, in case a blank or half-completed form is mistaken for an order not to resuscitate, as a patient enters cardiac arrest. At Conquest Hospital, run by East Sussex Healthcare trust, however, incomplete DNR forms were placed on patients' files.

A charity for the elderly has said the disclosures were evidence of "euthanasia by the backdoor," with potentially-lethal notices being placed on the files of patients simply because they were old and frail.

“In 2009, heart attack victim Peter Clarke was left to die at Derby Hospitals Trust after clerical staff inserted a DNR form into his notes.

Although the document was blank, nursing staff making handover notes misinterpreted it, and said the widower, who had been admitted suffering heart disease and flu-like symptoms, should not be resuscitated if his condition worsened.

When he suffered a heart attack, nurses did not call doctors to revive him. An hour too late they realised the DNR order was blank.

Last year an inquest into his death found staff had been "routinely" placing the forms in medical records before they had been signed and witnessed. The trust stopped the policy, and said it was not aware other patients had been affected.

The dossier of cases was gathered by Action on Elder Abuse because it believes that the NHS inspectorate is uncovering widespread failings, yet doing little to protect elderly patients in immediate danger – and nothing to highlight the misuse of DNR notices.

Gary Fitzgerald, the charity's chief executive said: "We believe that there is a real danger here that we are seeing euthanasia by default and by the back door.”

A culture of death pervades our hospitals and stalks their wards. Like LCP, DNR is being routinely used to dispose of those who are a ‘disproportionate’ tax on resources.

Asked how decisions to make such orders were made, staff at Royal Devon and Exeter NHS Foundation trust gave an example of an elderly person on the ward with health problems judged to make "resuscitation less appropriate". 

Katherine Murphy, chief executive of the Patients Association, said grieving relatives often only found out about the existence of the DNR notice after their loved one had died.

She said: "It is absolutely unacceptable, and it heaps so much distress on families."

Mrs Murphy said that there had been enough reports highlighting hospital failings, and called on CQC to "take action," including closing services which were not safe.