Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order – Chief Medical Officer response

 

Following reports in England, Epilepsy Scotland had significant concerns about people with a learning disability and other additional needs being blanket contacted for a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order.

We issued guidance in the interim, and contacted the Chief Medical Officer (CMO) for Scotland to seek clarity and reassurance this would not happen in Scotland. We received a very quick and reassuring response back, please see below.

 

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) – Learning Disability

Thank you for your letter dated the 15th of April highlighting your concerns over the use of DNACPR forms. I feel this issue deserves a speedy response because I want to reassure you that I am keen to resolve any ambiguity as soon as possible.

You may also be aware that the First Minister made a commitment last week during First Minister’s Questions that this matter is being taken forward by the medical professionals who advise the Scottish Government.

Please be assured that disability, including a learning disability, alone is not ever a reason for completion of a DNACPR form.

Our health care professionals work to very high standards of clinical and ethical guidelines and our recently issued COVID-19 Guidance on Ethical Advice and Support Framework is firmly rooted in the principal that everyone matters, equally.

All patients should be offered good quality and compassionate care and should be treated as individuals, and not discriminated against.

We are currently updating our clinical guidance to ensure that there is clarity in relation to the use of the Clinical Frailty Scale (CFS) which will make it as clear as possible that this should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism. An individualised person centred assessment is recommended in all cases where the CFS is not appropriate.

Additionally we recently issued a letter to GP practices to provide further advice and support on having anticipatory care planning conversations and to make clear that there is no requirement for health professionals to have a DNACPR discussion as part of this conversation, unless the patient wishes to discuss it or clinician feels strongly it is necessary to raise in conversation for the patient’s wellbeing. I have emphasised to Scottish GPs that DNACPR conversations must not be done on a blanket basis.

This is a demanding and challenging time for the NHS and all Health and Social Care professions and we continue to work closely with Health and Social Care Partnerships to ensure that we collectively support the most vulnerable people in our communities.

I would like to thank you for bringing this to our attention and for the work you are doing to support people with learning disabilities in Scotland despite the clear challenges that we face.

Together we will focus our efforts to achieve our shared objective – the protection and support of Scotland’s people during and beyond these unprecedented challenges.

Dr Gregor Smith

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