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| Thousands 'not told about' do not resuscitate orders | Thousands 'not told about' do not resuscitate orders |
| (35 minutes later) | |
| Thousands of people in England are having "do not resuscitate" orders imposed on them without their family's consent, an audit has found. | Thousands of people in England are having "do not resuscitate" orders imposed on them without their family's consent, an audit has found. |
| The Royal College of Physicians' audit of 9,000 dying patients found one in five families had not been told orders had been imposed on their relative. | The Royal College of Physicians' audit of 9,000 dying patients found one in five families had not been told orders had been imposed on their relative. |
| Prof Sam Ahmedzai told the Telegraph it is "unforgivable" not to tell families. | Prof Sam Ahmedzai told the Telegraph it is "unforgivable" not to tell families. |
| NHS England said there had been improvements in end-of-life care, but that more could be done. | NHS England said there had been improvements in end-of-life care, but that more could be done. |
| The audit estimated that 200,000 patients a year are issued with an order not to attempt to resuscitate them if they stop breathing or their heart stops. | The audit estimated that 200,000 patients a year are issued with an order not to attempt to resuscitate them if they stop breathing or their heart stops. |
| A good death: Can guidelines really help? | |
| 'My brother's Do Not Resuscitate order was horrific' | |
| Professor Ahmedzai, chairman of the audit, said in many cases there was no relative available, or families could not be contacted in time. | Professor Ahmedzai, chairman of the audit, said in many cases there was no relative available, or families could not be contacted in time. |
| However, doctors and nurses needed to "do better" in terms of communicating with family members, as current practices were "not really acceptable", he said. | However, doctors and nurses needed to "do better" in terms of communicating with family members, as current practices were "not really acceptable", he said. |
| "I think everybody has the spirit and the wish to do it. It's just that doctors and nurses are very busy in the front line," he said. | "I think everybody has the spirit and the wish to do it. It's just that doctors and nurses are very busy in the front line," he said. |
| "They are having to tend to lots of other things, including trying to cure patients alongside caring for those who are dying. And one of the things that goes when we are very, very busy is that attention to communication." | "They are having to tend to lots of other things, including trying to cure patients alongside caring for those who are dying. And one of the things that goes when we are very, very busy is that attention to communication." |
| There are large training programmes across the country to try to improve communication with families, he said. | There are large training programmes across the country to try to improve communication with families, he said. |
| DNR - Do Not Resuscitate | |
| DNRs are "Do Not Resuscitate" orders. A DNR order on a patient's file means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering. | |
| The usual circumstances in which it is appropriate not to resuscitate are: | |
| Guidelines issued by the British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussion with patients or their family. | |
| Read more from the BBC about DNRs | |
| In 16% of the 9,000 cases audited, the study also found there was no record of a conversation with the patient about the order. | In 16% of the 9,000 cases audited, the study also found there was no record of a conversation with the patient about the order. |
| Professor Ahmedzai said doctors needed to be more open with dying patients - particularly as half of patients identified as likely to be dying were dead within a day. | Professor Ahmedzai said doctors needed to be more open with dying patients - particularly as half of patients identified as likely to be dying were dead within a day. |
| "This is being done very late in the day - as doctors we just don't like to face up to it," he added. | "This is being done very late in the day - as doctors we just don't like to face up to it," he added. |
| 'More to be done' | |
| An NHS England spokeswoman said: "We welcome the results of this audit, which we commissioned, and which shows there has been some improvement in the care provided. | An NHS England spokeswoman said: "We welcome the results of this audit, which we commissioned, and which shows there has been some improvement in the care provided. |
| "But there is clearly more that can be done. | "But there is clearly more that can be done. |
| "Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made." | "Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made." |
| In June 2014, the Court of Appeal in England ruled doctors have a legal duty to consult and inform patients if they want to place DNR order on their medical notes. | In June 2014, the Court of Appeal in England ruled doctors have a legal duty to consult and inform patients if they want to place DNR order on their medical notes. |
| The issue was raised by a landmark judgement that found doctors at Addenbrooke's Hospital, in Cambridge, had acted unlawfully in the care of Janet Tracey. | The issue was raised by a landmark judgement that found doctors at Addenbrooke's Hospital, in Cambridge, had acted unlawfully in the care of Janet Tracey. |
| In December, East Kent Hospitals NHS Trust apologised for placing a DNR order on a patient with Down's Syndrome - having listed his learning difficulties among the reasons for doing so. | In December, East Kent Hospitals NHS Trust apologised for placing a DNR order on a patient with Down's Syndrome - having listed his learning difficulties among the reasons for doing so. |
| Have you been affected by the issues raised in this story? You can email haveyoursay@bbc.co.uk with your comments. | Have you been affected by the issues raised in this story? You can email haveyoursay@bbc.co.uk with your comments. |
| Please include a contact number if you are willing to speak to a BBC journalist. You can also contact us in the following ways: | Please include a contact number if you are willing to speak to a BBC journalist. You can also contact us in the following ways: |
| Or use the form below | Or use the form below |