The rights of people close to the patient
The loved ones of a patient are often entitled to be involved in DNR decisions, even if they are not the patient’s appointed legal representatives. They cannot make legally binding decisions on the patient’s behalf, however, so the final decision will be made by the senior treating doctors.
Those close to the patient can include family members, friends, and carers who have been involved in the patient’s care.
There are some limited situations where those close to the patient cannot be involved in a DNR decision:
- When the patient has requested that loved ones should not be consulted or involved. Patient confidentiality means that doctors would be unable to discuss the patient’s case with their loved ones in this situation.
- When the patient has lost mental capacity but has made a legally binding Advance Decision.
Health and welfare attorneys and personal welfare deputies
If the patient does not have mental capacity, legal representatives of the patient have more rights, in general, to be involved in any DNR decision.
Attorneys appointed under a Lasting Power of Attorney for health and welfare, and personal welfare deputies appointed by the Court of Protection must be consulted by doctors when making a DNR decision.
The powers granted under the Lasting Power of Attorney or deputyship order from the court must give the legal representative the power to make decisions about medical and life-sustaining treatment.
If a patient’s legal representatives disagree with the treating doctors over a DNR decision, they may have legal standing to contest the matter in court. This is a complicated area of law and it is always recommended to seek specialist legal advice if you choose to take this step as the patient’s legal representative.
Planning for the future and advance preparation for DNR decisions
No one wants to imagine a future where they may face a DNR decision, but at the same time, many people feel strongly about the circumstances in which they would, and would not, want their lives to be preserved.
If you are unable to communicate your wishes regarding CPR at the necessary time, there are steps you can take in advance to prepare for this. Doing so can give you peace of mind, knowing that matters are taken care of should the worst happen. It also allows you to make your decision calmly, removed from the distress involved when deciding in an emergency situation.
Lasting Powers of Attorney for health and welfare
A Lasting Power of Attorney allows you to appoint people to take decisions on your behalf if you do not have the mental capacity to make those decisions yourself.
Lasting Powers of Attorney for health and welfare allow you to give your attorneys the authority to make decisions regarding matters as diverse as your daily routine, where you live, the care you receive, and also your medical treatment.
This kind of Lasting Power of Attorney can only be used if you have lost mental capacity.
One of the powers you may confer on your attorneys is the ability to refuse life-sustaining treatment. This can include refusing CPR through a DNR decision. However, this power must be expressly included in the terms of your Lasting Power of Attorney, otherwise the decision will be made by doctors.
It is also recommended to discuss your thoughts on any potential DNR decisions when you create your Lasting Power of Attorney. This way, your attorneys are aware of your wishes if they have to make a DNR decision for you in the future.
Advance Decisions are documents which allow you to specify situations in which you would refuse certain kinds of medical treatment in future. Like Lasting Powers of Attorney for health and welfare, they will only take effect if, at the time of the medical treatment in question, you do not have mental capacity.
Life-sustaining treatment can be refused through an Advance Decision and, if the Advance Decision is valid and applicable to your healthcare situation, it is legally binding upon the doctors treating you.
Even if the criteria of your Advance Decision are not fully met, its terms can be taken into consideration as an indication of your wishes. Medical professionals will not be legally bound by the terms, however.
This means Advance Decisions have to be drafted carefully, both to comply with various formalities and to ensure it will accurately give effect to your wishes.
Also, if you make an Advance Decision, it is important to consider how it might clash with any Lasting Power of Attorney you have also made. If the two contradict each other, or do not align with the wishes you have communicated to your attorneys, it can make the situation difficult to resolve.