The man, whom she’d never seen before, explained that he’d come to talk about her future healthcare and raised the prospect of treatment being withheld should Lucy’s heart fail.
Sprightly Lucy, who lives independently, regularly walks to the corner store with her shopping trolley or takes the bus to the supermarket, was understandably upset.
Fit to knit: Last week, the Mail revealed the shocking story of 93-year-old Lucy Jeal (pictured), who recently received a ‘surprise’ visit at her South London council flat from an NHS ‘frailty nursing practitioner’
She cooks for herself, is an expert knitter, has a sharp memory, reads a newspaper every day, and looks forward to visits from her devoted family and especially playing with her young great-grandchildren.
All in all, Lucy enjoys a good quality of life and apart from some age-related ailments, she had been rated as ‘three’ on the NHS Clinical Frailty Scale (one is ‘very fit’ and nine is ‘terminally ill’).
Despite all this, the morning after the nurse’s unannounced visit to conduct a ‘frailty review’, an envelope was delivered to Lucy’s flat containing an A4-size notice with a stark red border.
Designed to be displayed in her home, it was a ‘Do Not Attempt To Resuscitate Order’ — known as a DNAR or DNR — and it stated that Lucy should not be resuscitated by doctors, nurses, or emergency paramedics if her heart stopped. It was signed by the frailty nursing practitioner.
‘I was shocked the NHS won’t save me. If I collapse, they are refusing to put me together again,’ Lucy told the Mail.
Lucy is one of millions of people who have been caught up in a new — and, no doubt, well-intentioned — NHS initiative to help those over 65 live at home and not burden hospitals.
As part of this, individuals are encouraged to make early decisions about ‘advanced care’ and sign a DNAR.
However, concern is growing about the pressure put on older people to accept DNARs. An urgent review has condemned their ‘blanket use’ in care homes at the peak of the Covid-19 crisis earlier this year.
Designed to be displayed in her home, it was a ‘Do Not Attempt To Resuscitate Order’ (pictured) — known as a DNAR or DNR — and it stated that Lucy should not be resuscitated by doctors, nurses, or emergency paramedics if her heart stopped. It was signed by the frailty nursing practitioner
Health watchdog the Care Quality Commission says many were put on medical records without the consent of the person concerned and their families.
Lucy Jeal’s horrified family say Lucy never agreed to the DNAR order, which was also sent to her GP. The family now want the order removed from her medical records.
Lucy’s experience struck a chord with readers up and down the country, and we have received hundreds of letters and emails from people sharing their distress at receiving, or seeing their loved ones receive, DNARs without discussion or their permission.
Here we present a small selection of the letters.
THE CONSULTANT WENT ON AND ON ABOUT IT
My husband, 80, has had a number of serious health problems over 15 years and in September became ill and took to his bed.
The community matron was fantastic and gave us support. But, on her second visit, she was accompanied by a geriatric medicine consultant who went on and on about how a DNAR would make his passing over as easy as possible. She was unstoppable, even resorting to describing horrible ways to die which could happen without a DNAR.
I feel there must be some sort of incentive for doctors to give out DNARs. Perhaps it’s just to keep the elderly out of hospital.
Mrs Chris McGuinness
My husband is 77 and suffers from chronic lymphocytic leukaemia. Recently the consultant called us both in, and tried to persuade us that my husband should agree to a DNAR order.
Although we have not given any such consent, it appears to have been forced on him. The latest letter to his GP, which was also sent to us, re-states that DNAR is the plan.
A complete stranger came to my house saying she was a nurse from my GP. She told me: ‘You have said that you would not want to be resuscitated in the event of a heart attack’. I was taken aback and asked her to repeat what she had just said. I had no memory of any such thing. She left, saying: ‘I’ll post a copy to you’.
A DNAR form arrived in the post, saying I was expected to die within a year.
DOCTORS ARE PLAYING GOD
My Dad is 73 and has health issues. On leaving hospital in early November (following treatment for an infection and also after catching Covid while on the ward), my mum found a Do Not Resuscitate Order hidden in his medical notes, which he did not know about and had never discussed.
My strong ex-soldier dad was really frightened and we want to get the order retracted. Doctors are playing God.
Sarah Sheer Keith
I am a fit 66-year-old who underwent a procedure at my local hospital last week with anaesthesia. I am fit for my age with no health problems — but at my pre-op appointment the nurse asked if I had a DNAR in place.
Lucy is one of millions of people who have been caught up in a new — and, no doubt, well-intentioned — NHS initiative to help those over 65 live at home and not burden hospitals. As part of this, individuals are encouraged to make early decisions about ‘advanced care’ and sign a DNAR
I FEEL PENALISED FOR BEING OLD
I am 77 and was contacted by my GP in early April. I had not been to the doctor for ten years. They had made an appointment to speak to me, which I found odd. With hindsight I realise that they only wanted to insert ‘Do Not Resuscitate’ on my medical records.
I told the doctor I would prefer her not to do so. I later decided to write to the surgery requesting confirmation of my decision.
I am horrified at what is happening. My trust in the medical profession has completely dissipated. The attitude of the Government towards older people makes me feel I am being penalised for a crime I haven’t committed.
My father celebrated turning 100 on March 7 with a party for 80, including his lady friend. Although partially blind, he is in good health for his age and lives on his own with full mental capacity.
On November 4, I received a call from my local surgery to let me know they were arranging a routine check up on him. A Welsh version of the DNAR form was left on the mantelpiece. He does not speak Welsh, so I got it translated. It indicated not for resuscitation because of age and frailty.
Clinton A. Cook
IT’S LIKE A DOUBLE DEATH SENTENCE
At 75 in August 2019, I was given a terminal diagnosis — acute myeloid leukaemia. The prognosis was six to 12 months. I was told at the clinic that a ‘Do Not Resuscitate’ notice had been sanctioned on my medical records. Since then I have been living with a two-fold death sentence hanging over me.
My 96-year-old mother was taken to hospital after a fall in April this year. I received a phone call from her the next morning. She was very distressed, saying she didn’t think she had long to live and wanted to speak to me before she died.
She said the doctor had told her the fall had affected her heart and they wouldn’t be able to save her if she had a heart attack.
I had a call from a young-sounding registrar to inform me the doctor was putting a DNAR notice on her because of her age. She was sent home with the notice.
My husband, 79, was admitted to hospital in June this year. He returned home after a week. I was emptying his bag and came across a Do Not Resuscitate form.
I, as his wife, had not been contacted and he has no idea who the doctor is who signed it. I felt really angry the NHS could do such a thing: they are supposed to save lives, not end them.
WE THOUGHT IT WAS A CHRISTMAS CARD
My husband, 78, was recently admitted to hospital with pneumonia. He was discharged and we found in his hospital carrier bag a brightly coloured yellow envelope. He jokingly asked if it was an early Christmas card. To our horror it was a DNAR form.
Until that moment he had no idea that this piece of paper was in his possession as nothing had ever been mentioned to him. We find this very frightening.
I am 91 and recently attended a fall risk-assessment clinic and, afterwards, my GP phoned to discuss it. She asked: ‘How do you feel about being resuscitated in the event of any further mishap?’
I was shocked at such a question, being a lively kind of person with no intention of meeting my maker — yet, anyway.
All in all, Lucy enjoys a good quality of life. She cooks for herself, is an expert knitter, has a sharp memory, reads a newspaper every day, and looks forward to visits from her devoted family and especially playing with her young great-grandchildren
I am 76 years old and went into hospital for a lung biopsy in October. Before the procedure, the nurse asked me: ‘Have you signed a DNAR form at your doctor’s?’
When I said I had not, she replied: ‘You can sign it now if you want.’ So I did.
My 87-year-old mother lives with her husband (my dad) and me at home with carers coming in four times a day.
In September she had an episode. The following day a doctor came out. I didn’t recognise him or his name but he said he was from our surgery.
As he was leaving, he started talking about a DNAR. He reminded me of a sales person who was trying to ‘sell’ DNARs. Then the Frailty Team started coming out. I found they were set up to keep the elderly out of hospital.
The team made an appointment for a consultant to come and discuss ‘things’. I warned them we were not going to talk about a DNAR.
A few days later they phoned to cancel the appointment saying the consultant didn’t see any point in coming out if we weren’t going to discuss it.
THEY ARE CARRYING OUT EUTHANASIA
My mother was recently in hospital due to an infection. We were not allowed to visit because of the pandemic and they made a clinical decision to put a DNAR on her, of which she wasn’t aware.
She has been discharged but is frightened of going back in. How can we trust healthcare to do the best for our elderly when they are carrying out euthanasia?
MY WIFE FELT UNDER PRESSURE TO AGREE
My wife, who is 68, has multiple sclerosis, type 2 diabetes, and is being treated for pancreatic cancer, was sent by ambulance to our local NHS hospital.
After returning home, to my horror, she showed me a ‘Do Not Resuscitate’ letter that, in her confused state, due to a high temperature and infection, she had felt under pressure to agree to. I, as her husband, was not even consulted.
I collapsed at home in July this year. I was taken by ambulance to my general hospital 35 minutes away.
In A&E, I was examined and put on oxygen. Two men looking like vultures considering their next prey arrived with no introductions. They looked over the end of my bed and commenced to lecture me on DNAR and the problem for the NHS staff if I was to need intense treatment. I am 75, had pneumonia, and have now recovered.
My husband became very ill with a lung problem in March this year, but we managed to keep him at home although the GP refused to see him.
They just spoke over the phone telling us to ring 111. At 71, he had been very active up to this point walking and cycling.
A nurse at the GP practice rang up to talk him about a DNAR, saying it was policy. This made him feel even worse.
The same nurse rang back a couple of days later. I said she was never to ask my husband again about a DNAR. I couldn’t believe that this was being discussed.
He’s now getting back to fitness and walking the dogs again.
BUT NOT ALL READERS BELIEVE THEY’RE A BAD THING
Two years ago my father, who was then 92 and had had a heart attack, was asked by a hospital doctor, in the presence of me and my brother, if he would want to be resuscitated if his heart failed completely.
My father elected not to be resuscitated and we agreed to support him on this. But it was up to my father to make the decision himself.
The medical professionals communicating how the DNAR works would seem to need more training.
Resuscitation is a brutal, harsh treatment, often breaking ribs and putting huge strain on the bodies of patients. Of course, to save life, it is often necessary, but in the elderly, especially the very elderly, outcomes are not good.
This doesn’t mean the patient doesn’t get as much care as is possible, but to wreak such damage on frail bodies is reasonably regarded as not in their best interests. Having watched this process at close hand I have already signed an order and I am only 69.
In a pandemic where resources are even more limited than usual, decisions have to be based on the benefit of the many — concentrating on the treatment regime which is likely to succeed.
The elderly should have a conversation with their family about death, and whether they would prefer to slip away peacefully or be subjected to clinically invasive, usually futile, procedures.
Stephen Biddle, Former critical care charge nurse