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According to a study presented at the May 2014 American Thoracic Society International Conference in San Diego, Massachusetts General Hospital’s ethics committee has had a policy allowing unilateral do-not-resuscitate (DNR) orders since 2006. These orders, as defined by the study’s authors, are “a specific type of medical futility decision in which clinicians withhold advanced cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest despite objections of patients or their surrogates.” (Emphasis added.)

Researchers studied all the ethics committee’s consults involving DNR conflicts between doctors and their patients or the patients’ surrogate decision makers since 2006. There were 147 cases where there was conflict over intensity of treatment and DNR status. The ethics committee recommended a unilateral DNR order 35% of the time. That recommendation was implemented in 83% of those cases.

The study found that a patient’s age, gender, and functional status prior to being hospitalized were “not associated” with a unilateral DNR recommendation, but non-white patients and “patients judged to have end stage conditions” were more likely to have a unilateral DNR recommended by the committee. Researchers also found that patients who actually were issued unilateral DNRs were more likely to die in the hospital. [Medical Futility Blogspot, 5/11/14]

PRC consultant Wesley J. Smith called the Massachusetts General policy “a medical tyranny.”
[Summer 2014, Vol.28, No.4, Patients Rights Council Update, ]



UK: Two Landmark Court Rulings Address Euthanasia and DNR Orders
…Aiding Those Seriously Disabled to End Their Lives

The British Supreme Court has dismissed an appeal, brought by Paul Lamb and the widow of Tony Nicklinson, claiming that the law against euthanasia and assisted suicide violates the right of the disabled to respect for private and family life under Article 8 of the European Convention of Human Rights (ECHR). Lamb is paralyzed as a result of a car accident and Nicklinson had “locked-in syndrome”—neither physically able to end their lives without direct assistance. The Court held that, while it had the constitutional authority to rule on whether the law violates Article 8, Parliament is better situated to make such an assessment. [Supreme Court, Nicklinson v. Ministry of Justice, 6/25/14]



…DNR Orders and Patient Rights (UK)

The Court of Appeals in London has ruled that doctors have a legal duty to first consult with and then inform patients or their families if a do-not-resuscitate (DNR) order will be placed in a patient’s medical records. Not to do so would violate a patient’s rights to physical integrity and autonomy protected by Article 8 of the ECHR. Justice Lord Dyson, who authored the ruling, wrote, “…since a [DNR] decision is one which will potentially deprive the patient of life-saving treatment, there should be a presumption in favour of patient involvement. There needs to be convincing reasons not to involve the patient.” [Court of Appeals, Tracey v. Cambridge Unit Hospital NHS Foundation Trust, 6/17/14]

The case, which had been rejected by a lower court, was brought by the family of Janet Tracey, 69, who had been diagnosed with lung cancer and subsequently suffered a broken neck in a car accident. Tracey’s daughter found the DNR order in her mother’s hospital records, placed there without her mother’s or the family’s knowledge and against her mother’s wishes.
[Summer 2014, Vol.28, No.4, Patients Rights Council Update, ]