Report shines new light on the abuse of DNR orders and the sickening neglect of those deemed expendable, argues Caitlin Southern

Of all the outrages that have come to light during the course of the coronavirus pandemic, one of the worst was the decision to impose automatic ‘Do Not Attempt Resuscitation’ (DNR) orders on particularly vulnerable patients without their knowledge or consent when the pandemic was at its height. This has largely been forgotten in the wake of everything that has happened since but a study conducted by the Queen’s Nursing Institute brings it back to the forefront.

In an attempt to free up acute hospital beds, care home residents were forcibly discharged into facilities that did not have the scope to manage the illness, some without Covid tests being performed and others who had tested positive. The attempt to force blanket DNR orders was imposed by NHS managers, with no possibility of discussion with care home staff, patients or their relatives. It is important to stress that the decision was not taken on the basis of medical evidence or advice, but in the initial panicking stage of the pandemic response where the goal was to avoid intensive care units being overwhelmed, seemingly at any cost.

The imposition of DNRs on certain predetermined sections of the population demonstrates a callous disregard for the lives of those people and plays into the narrative of some sacrificing themselves for the good of all that was used to pressure health and social care staff into working without the right PPE.  This highly damaging idea was fostered to allow the government to push the agenda of a state apparatus that is not responsible for the wellbeing of the population, instead passing the responsibility onto said populace.

The government claimed that there was a protective ring around care homes, but this was patently untrue as residents were refused access to medical care and left where there was a higher risk of infecting others rather than being admitted to hospitals or visited by doctors. This failure to ensure the protection of both staff and vulnerable residents, while shifting the blame onto them, demonstrates yet again the contempt in which the government holds people it considers to be ‘unproductive’.

Care home staff refused to comply with the orders because they saw them for the unethical abuses that they were, and the blanket use of automatic DNRs was abandoned when they became widely known.  It was always clear that the use of DNR orders in this manner is deeply morally wrong, but with the massive underfunding that health and social care services have faced, some managers will have felt pressured into complying. The orders equally targeted the elderly and those with learning difficulties – people whom government policy has already seriously disadvantaged and whose lives have been portrayed as worth less than those deemed economically productive.

Social care has long been the poor relation in healthcare, abandoned and imposed upon.  This cannot continue into the second wave if we are to avoid yet more unnecessary deaths. To mitigate the coming surge, social care workers must be fully included in all decisions as they have the hands-on experience and understanding of their residents’ needs that will help to keep those residents safe. Whether this happens or not, however, depends on government and health service managers being willing to work with people they have so far excluded.  While not impossible, this seems highly unlikely unless we maintain the pressure on them to protect those most at risk.