COVID-19 and the lawfulness of bulk do not attempt resuscitation orders

The issuing of bulk do not attempt resuscitation notices (DNAR) on older and vulnerable people has been relatively commonplace during the COVID-19 pandemic. A GP practice in South Wales issued a standardised letter to vulnerable patients informing them that they were having a DNAR notice placed on their file (Busby, 2020). In England, a report found that care homes were advised by some clinical commissioning groups and GP practices to place all their residents on DNAR orders (Knapton, 2020).

With a second wave of COVID-19 expected to compound the usual pressures on the NHS through the winter it is essential that nurses apply the law and professional duty accurately when considering DNAR orders.

DNAR notices avoid the inappropriate use of cardiopulmonary resuscitation (CPR) in hospital and settings such as care homes. The notice applies to CPR only and does not exclude the provision of other active interventions, care and treatment by nurses. A DNAR notice also protects nurses and other care workers from an allegation of wilful neglect under the Criminal Justice and Courts Act: section 20(1) (R v Patel [2013]).