Not resuscitating older people

I was surprised when a very old man told me that he had signed a DNAPR during an unaccompanied outpatient visit. He recounted how a nurse approached him as he waited and asked him to sign a piece of paper, which he had declined to sign on several previous occasions, but he gave in this time because he will refuse to be ‘carted off’ to hospital if he fell ill again. This experience has echoes of the experience of some older people during the first peak of the pandemic (Care Quality Commission (CQC), 2020) over which there was an outcry.

Griffiths (2018) set out clearly the legal position regarding a DNAPR and the protection that a lawful DNAPR offers district nurse (DNs). Crucially, a lawful DNAPR protects DNs from allegations of wilful neglect or ill treatment. Griffiths (2018) noted that a DNAPR may only be used when attempts at resuscitation would be futile; they would be against an individual's wishes or when not in the best interests of an incapable person. But, importantly, a DNAPR only applies to resuscitation and does not refer to any other treatment or care interventions, which should continue to be delivered and meet expected quality standards. There is a requirement to consult the individual; if they lack capacity, those holding power of attorney for health and welfare must then be consulted unless the individual has made a ‘living will’-that is, there is a legal statement from the individual stating what medical treatments/interventions they do not want.