Judge rules in favour of “do not resuscitate”

BMJ 1996; 312 doi: (Published 04 May 1996) Cite this as: BMJ 1996;312:1115
  1. Clare Dyer

    Doctors caring for a severely disabled 23 year old man need not resuscitate him if he has a heart attack or stops breathing, ruled Sir Stephen Brown, England's senior family judge last week. The case went to the High Court in London because staff in the day centre where the man, named as R, spends some of his time had challenged South Buckinghamshire NHS Trust's decision to apply a “do not resuscitate” policy to him.

    The Public Law Project, a legal charity, had won leave to seek a judicial review of the decision, but instead the trust applied to the court's family division for a declaration that the policy was not unlawful. Sir Stephen also declared that the trust need not give R antibiotics if he develops an infection that is life threatening, as long as his parents are consulted and agree with the decision. The Official Solicitor, appointed to represent R's interests, agreed with the terms of the declaration, as did R's parents.

    R functions on the level of a newborn baby. He reacts to pain and distress and smiles when cuddled, but it is doubtful whether he can see or hear. Sir Stephen said: “His parents, his doctors, and the selfless care workers will continue to make his life as bearable and as comfortable as possible until a crisis occurs which will result in nature taking its course and R being relieved of intolerable suffering.”

    R's parents said that they were “astonished, shocked, and deeply hurt” by the care workers' action in bringing the case to court. “There was an appalling breach of confidentiality on their part and it is to be hoped that social services departments will lay down clearer guidelines before their employees interfere without consultation.”

    The trust's do not resuscitate policy was based on guidelines issued by the BMA and Royal College of Nursing to the effect that decisions on resuscitation should depend on the likelihood of success, quality of life, wishes of the patient or his family, and the patient's best interests. But it had been drawn up by doctors who did not take legal advice, and it differed from the guidelines in some respects. The trust has now brought its policy into line with the guidelines.

    Stephen Cragg, solicitor with the Public Law Project, said: “We hope that other authorities will scrutinise their own policies and guidelines in the light of this case and will now be aware that these may be subject to legal challenge if they are not in accordance with the law.”—CLARE DYER, legal correspondent, BMJ

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