Paul Murphy
Question:692. Deputy Paul Murphy asked the Minister for Health if he will provide details of the blanket DNR (do not resuscitate) that was put in place in nursing homes in March and April 2020. [60919/22]
View answerTuesday, 6 December 2022
Questions (692)
Written answers
To ensure that Do Not Attempt Resuscitation (DNAR) orders are made consistently, transparently and in line with best practice, the Health Service Executive (HSE) provides guidance regarding advance care planning including making DNAR decisions. The HSE National Consent Policy 2019 – Part 4 Do Not Attempt Resuscitation - provides a decision-making framework that facilitates the advance discussion of personal preferences.
The Department of Health and the HSE developed a broad range of national ethical and clinical guidance throughout the course of the COVID-19 pandemic with a view to supporting healthcare workers, managers, and policy makers as they navigated their way through the ethical challenges and difficult decisions they were called upon to make during this challenging time.
The Department of Health published an Ethical Framework for Decision Making in a Pandemic in March 2020 which contained a set of ethical principles and procedural values to support and inform policy-makers, health care providers and clinicians in decision-making during the pandemic. Further guidance issued on the delivery and provision of healthcare matters, including Ethical Considerations Relating to Long-Term Residential Care Facilities in the context of COVID-19. This document specifically references blanket policies on DNARs and states – “Blanket policies relating to decisions such as transfer or non-transfer to hospital or Do Not Attempt Resuscitation Orders (DNAR) orders, should a resident become seriously ill due to COVID-19 or any other condition, are inequitable and discriminatory.”
The HSE also published a number of guidance documents to support clinicians. This includes Guidance Regarding Cardiopulmonary Resuscitation and DNAR Decision-Making during the COVID-19 Pandemic published in May 2020. This guidance was applicable to all care environments where services are provided for and on behalf of the HSE including acute hospitals, the ambulance service, community hospitals, residential care settings, general practice and home care. This guidance states - “There should be no discrimination for or against persons who have or are suspected to have COVID-19 in relation to DNAR decisions. Individualised care is at the heart of good clinical practice. The pandemic does not justify any healthcare workers deviating from that approach by making DNAR decisions on a group basis. Such a decision would be contrary to all guidance and human rights principles.”
The purpose of these guidance documents was to support clinicians in their care of patients and service users, including in respect of the making of appropriate clinical decisions. Such decisions, on the provision of healthcare or the transfer to another healthcare facility, are arrived at in consultation between the clinical experts and the resident or his or her representative, and in recognition of the needs and wishes of the resident.
Question No. 693 answered with Question No. 688.