DNR order on kids with disabilities

[2021s]

Sorry about the daily mail link but this is too shocking not to share. DNR orders placed on teenagers with learning disabilities during pandemic in England.

www.dailymail.co.uk/news/article-10346479/GPs-offered-teenage-patients-learning-disabilities-not-resuscitate-orders.html?fbclid=IwAR2Moljqum74qgnOkCbldVPCng0tUA9IWfUs6loTQQXdZBX_x9wGNk844jo

This is terrifying that it would ever be considered.

www.dailymail.co.uk/news/article-10346479/GPs-offered-teenage-patients-learning-disabilities-not-resuscitate-orders.html?fbclid=IwAR2Moljqum74qgnOkCbldVPCng0tUA9IWfUs6loTQQXdZBX_x9wGNk844jo

[quote Mickarooni]@Annna41

Isn’t is extremely common for ITU patients to be severely distressed and be hallucinating and experiencing cognitive and mental health distress? I’m genuinely asking because my personal and professional experience is that people in ITU rarely are compliant and quiet.[/quote]
No actually. Just the occasional patient is confused.

@JumpingPiglets, not what I'm suggesting at all. People were admitted based on likely outcome of successful treatment.

To to those who would choose on clinical need.....

You have two beds that have become available. There are 24 patients through the hospital who will die today without more invasive treatment and another 32 who will be in that position tomorrow.

What criteria do you used to decide who gets the two beds and which 22 will die?

This was the reality.

None of us want patients to die, especially the valuable. It's Sophie's Choice and I'm so grateful that I didn't have to make those decisions.

[quote Annna41]@JumpingPiglets, not what I'm suggesting at all. People were admitted based on likely outcome of successful treatment.

To to those who would choose on clinical need.....

You have two beds that have become available. There are 24 patients through the hospital who will die today without more invasive treatment and another 32 who will be in that position tomorrow.

What criteria do you used to decide who gets the two beds and which 22 will die?

This was the reality.

None of us want patients to die, especially the valuable. It's Sophie's Choice and I'm so grateful that I didn't have to make those decisions.[/quote]
Clinical need.

Regardless of everything else that’s going on, you make a decision based on the clinical facts. That’s it. Anything else is unethical and possibly illegal.

I read it ATT.
Awful only the fittest survive when it comes down to the bones.

@ineedsun
They all have a clinical need. Without a bed they're all dead.
What clinical facts do you use to decide?

@Annna41 - it is horrific and I really feel for the staff making those decisions. I still think whatever criteria you use, they have to be applied to individual. I cant see whats controversial about that.

[quote Annna41]@ineedsun
They all have a clinical need. Without a bed they're all dead.
What clinical facts do you use to decide?[/quote]
@Annna41 so in making an assessment based on facts other than clinical need was disability taken into account as a reason for withholding treatment?

Did it occur to you that this might be unlawful?

@Emerald5hamrock

I read it ATT. Awful only the fittest survive when it comes down to the bones.

Sadly we didn't have enough beds, equipment or appropriately trained nurses. Why do you think so many staff are off with PTSD? Again who would you choose for your two beds?

It's so easy to say based on clinical need but the reality is they all had a need.

I'm just interested how you would choose?

[quote Annna41]@ineedsun
They all have a clinical need. Without a bed they're all dead.
What clinical facts do you use to decide?[/quote]
I’m not sure if you’re being deliberately obtuse.

You weigh up all the factors affecting the person right now and their likelihood to survive. You don’t decide, based on a person’s protected characteristics that they shouldn’t have access to the same consideration for treatment as everybody else.

Let’s see if this helps, you have two people needing the same bed, one is white male below knee amputee the other is white male able-bodied. Which do you choose?

However, this thread is about DNRs being blanket applied to a group of people with a specific disability not access to limited beds (although I know there are similarities).

[quote BusBusBus]@Annna41 - it is horrific and I really feel for the staff making those decisions. I still think whatever criteria you use, they have to be applied to individual. I cant see whats controversial about that.[/quote]
In our hospital it was. We had patients with various SN.

[quote Annna41]@ineedsun
They all have a clinical need. Without a bed they're all dead.
What clinical facts do you use to decide?[/quote]
Are you really suggesting that patients were denied escalation to ITU because of their learning disability? This certainly hasn't happened in my hospital over covid.

Concerns about compliance could be more of an indication to admit to ITU because of the higher staffing ratios and quicker escalation.

Denying someone treatment based solely on a disability is illegal.

@JumpingPiglets, not that I'm aware of in our hospital.

@ineedsun, not at all. Unfortunately it's the reality of what happened. I'm interested in your personal clinical judgement that you talk of. Of course blanket DNAR are hideous. My own grandfather had one and died of covid - because of his age!

Looking at this purely as a business decision.

Surely this is simply using resources most effectively and taking a cold hard business like decision. It may not be easy to swallow but decisions around what and who we save in limited resources rarely are. It is hardly shocking though as actually if you remove emotion from it and the Mumsnet attitude of spending everyone else tax money (some of these people have already had a massive spend more than their families often will ever pay in tax) to keep everyone going the medical professionals who are experts are making these decisions and hopefully they do it without emotion.

Terrifying as are some of the replies on this thread, I have a 15 year old with Down Syndrome. I’m currently getting myself in a flap about him returning to school, he’s double jabbed, booster not due until February. I’ve received 2 letters in the last week from the NHS and child development centre reminding me he’s CEV, the worry is keeping me awake at night.

@Annna41 - - well its fairer to flip a coin than bring in criteria irrelevant to the chance of survival and recovery. If you blanket ban learning disabled, you could blanket ban people with freckles or people with stairs in their houses or gay people.
The learning disability has to be relevant to why that individual wouldnt recover/survive as well or it shouldnt be part of the decision making process. For many people it will be relevant. For many it wouldnt.

[quote Annna41]@JumpingPiglets, not that I'm aware of in our hospital.[/quote]
That contradicts your posts where you state that everyone had clinical need and asked what factors other posters would take into account, which strongly suggested that disability was taken into account.

@hugr, no. I've already said several times that this was not the case in my trust. I looked after patient who had SN and covid

@JumpingPiglets not at all. As I said I am completely against blanket DNAR forms for anyone and it is not something that I witnessed.

However I am very interested in what criteria people think should be used.

[quote Annna41]@ineedsun, not at all. Unfortunately it's the reality of what happened. I'm interested in your personal clinical judgement that you talk of. Of course blanket DNAR are hideous. My own grandfather had one and died of covid - because of his age![/quote]
What ‘personal clinical judgement that I talk of’? My own? I haven’t claimed to have a clinical knowledge of this area, what I have said is that clinical decisions should be based on clinical assessment at the time, not DNRs based on a protected characteristic rather than a personal decision. I’m not a doctor, but I am a healthcare professional so I know about assessment and prioritisation based on need within my own specialism, I’m not talking out of my arse and I could hazard a guess as to some of the factors but I won’t even try because it’s not my speciality.

You haven’t answered my question about the two males, I notice. I wonder if that is because the question is ridiculous? Because it is, but it’s exactly the same as assuming that because someone has a learning disability that they have less of a right to life than someone who doesn’t.

Was your grandads DNAR applied without his informed consent, purely based on his age?

[quote Annna41]@JumpingPiglets not at all. As I said I am completely against blanket DNAR forms for anyone and it is not something that I witnessed.

However I am very interested in what criteria people think should be used.[/quote]
So what is your point then? This thread is about DNRs being applied as a blanket policy for people with LD. It’s not about who should get the ICU bed (which it seems that you agree should be based on clinical need not a blanket DNAR). Unless I’ve missed a point where it changed before you started posting.

I haven't answered it because it's above my pay grade so thankfully I don't make those decisions, neither would I ever want to.
Unfortunately some poor person does and they have to live with the what ifs. The whole situation has been traumatic for patients relatives and staff.
I wouldn't want that responsibility for all the tea in China.

@ineedsun "I saw routinely offered" in the original article. That was what I was replying to.

What I understand from @Annna41's posts is that her hospital did not have a written, blanket DNAR policy. But what she does seem to be referring to is assessments, ostensibly on a case by case basis, which de-prioritised disabled people, presumably on the basis that their positive outcomes would be lower. A handful slipped through the net. Now, that policy might not have been written down or articulated as a "blanket no DNAR for disabled people policy" - of course it wouldn't because most consultants are not that stupid - but if it waddles like a duck and quacks like a duck... well it ain't a fucking labrador.

I have no doubt that her hospital was forced into some very difficult decisions, and no doubt got some decisions wrong or made some decisions that were unlawful or unethical, not out of conscious desire to do so, but because of the pressures of the situation. But rather than acknowledge that and lay blame where it is due (if appropriate) - eg a government that has systematically reduced hospital beds over the last decade - she is defending what is frankly indefensible

@Newyearnewme2022

Terrifying as are some of the replies on this thread, I have a 15 year old with Down Syndrome. I’m currently getting myself in a flap about him returning to school, he’s double jabbed, booster not due until February. I’ve received 2 letters in the last week from the NHS and child development centre reminding me he’s CEV, the worry is keeping me awake at night.

Honestly if you are so worried I would keep him home untill he has his booster ,my eleven year old doesn't have down syndrome but he does have severe autism and learning disabilities at a special school etc , thankfully he's very healthy ,but some kids at his school have profound and multiple learning disabilities,and are extremely clinically vulnerable on oxygen etc I want my son to have his vaccination asap not only to protect him but his classmates.