15 March 2017

DNR- Professional Judgement, Unconscious ‘Otherness’ or a Case of Safeguarding

 An edited version of this article appeared in Community Care in 2016. There is an irony in the follow up treatment I receive in my visits to the consultant every few months. He remains amazingly friendly and impressed by my physical response to his treatment of the mask. Last time he referred in a meaningful way to a conversation “you and I had in the resuscitation room” and how good it was to see me so well and still able to work. (who else than disabled people are praised for working at 70!) Is an ironic smile appropriate!?

DNR- Professional Judgement, Unconscious ‘Otherness’ or a Case of Safeguarding

An ex social worker/ service user examines the issues

When adult safeguarding issues became a hot topic ten years ago and identifying the issues became the subject of the day, I didn’t feel it had a lot to do with me as an articulate, middle class user employing my own PAs. Indeed, I remember being asked to speak at one or two conferences to put the alternative view and I was pleased to stress the importance of not being prevented from taking risks. However, an occurrence a few months ago has made me think again on this subject.

I was rushed to A and E one Sunday morning with breathing problems and was diagnosed with pneumonia so was pleased to have the specialist’s help. As I wasmade to feel comfortable and came to, with a mask for breathing, (looking weak and helpless with joints riddled with arthritis) the consultant who’d assisted me, came to speak to me. He explained the diagnosis and treatment and then went on to describe how I could sign the form for Do Not Resuscitate (DNR) so that it was on my file.

Then everyone would know in the future that I did not want the struggle of being revived if the situation occurred again. I try to be obliging as a person and of course look up to doctors as we’ve all been trained to do so I agreed to it without thinking.

Half an hour later my husband was shown in to see me and I explained what had happened. He was rather shocked and said I shouldn’t agree unless I really wanted to and I began to see I hadn’t fully realised the implications of what the consultant had suggested. Then I was admitted for a couple of days and nothing more was said to me but it was impossible not to hear another consultant suggest the same course of action to two other people on their own with him behind ward curtains without their families.

It wasn’t until I was discharged home with the letter for the GP that I realised it was marked that DNR should be the course of action and so I had to be proactive if I wanted it changed. Fortunately my GP had some specialism in advising older people about this and so after a full discussion by phone he was able to cancel the instruction and change the paperwork.

I subsequently had excellent follow up treatment from hospital with a mask fitted to prevent the likelihood of further crises and regular visits to a specialist clinic to check on its effectiveness. The consultant couldn’t have been more positive about seeing both my husband and myself, valuing my still working part time and looking to the future and how worthwhile the treatment is. The DNR form has not been mentioned. So what does this experience show me?  I lay there as a grey haired, 70 year old disabled person, fitted with a mask, vulnerable and in an alien environment. Did the consultant see me, unconsciously, as in ‘another group’ he didn’t identify with so he followed professional protocol to the letter without thinking beyond what he could see in front of him? Was it only when I was back to normal and we could interact as people, did he appear to see me as a useful and valued member of society with implications for my being kept alive?

A few months later I wondered what to share about this experience, if any. I raised it at the user group run by the Users Network, linking to the council Safeguarding Board and chaired by the board chairman. I was pleased to find a shared understanding of the issue and it led to the group informing themselves of the required protocols by having a hospital speaker at their next meeting and the chair raising the issue at the Safeguarding Board.

How many others have found themselves in such vulnerable situations without family with them and a full understanding of the issues? How much are the pressures of costs of hospital beds leading to such safeguarding issues? What extra protocols need developing to prevent unconscious stereotyping we are all guilty of?

Clare Evans MBE