Covid-19 pandemic no excuse for ignoring rights of elderly: Age NI

Since the virus began spreading across the province in March this year, concerns have been raised that the elderly are not being afforded the same protections when accessing healthcare as their counterparts in Great Britain and the Republic of Ireland.

One particular area of concern is centred on the use of the ‘do not attempt resuscitation’ (DNACPR) forms in hospitals – with some elderly patients reporting that they felt pressured into signing one.

This is used to formally record that the patient does not wish any resuscitation efforts if they stop breathing or if their heart stops beating.

Age NI chief executive Linda Robinson said the elderly have every right to be treated no less favourably that other age groups.

“Age NI and other organisations have been campaigning for many years for older people to have the same legal protections as the rest of the UK and the Republic of Ireland when accessing goods, facilities and services, including health services,” Ms Robinson said.

“I, along with the Commissioner for Older People NI, and other organisations across the UK, issued two joint statements about the importance of upholding fundamental human rights principles at this time. We expressed specific concerns about shocking reports, where blanket decisions seem to have been made on the care and treatment options for older and vulnerable people who have felt pressurised into signing Do Not Attempt CPR forms.”

“We have heard from older people and families who are concerned about being able to access to the right care and treatment during the Covid-19 pandemic. We sense a genuine confusion over what DNAR means and the implications for end-of-life care.

“That’s why Age NI is urging everyone involved in the treatment of older people to make sure that older people and their families have clear information about any risks and benefits of treatment options, and, that their views and wishes are listened to.”

Ms Robinson added: “Finally, I would like to remind people that Age NI will continue to work in the best interests of older people. If you are concerned about yourself or a loved one, please call us on 0808 8080 7575.”

Last month, nine leading elderly advocacy bodies across the UK, including Age NI, called for rights to be protected.

They said: “We do not underestimate the significant pressures being faced by all staff working across our health and social care sectors at this difficult time, but it is crucial that we continue to protect people’s fundamental human rights. It would be completely unacceptable to abandon these rights in favour of taking blanket, discriminatory decisions.”

In March, as the devastating impact of the current crisis was becoming apparent, the same nine bodies said: We strongly believe that decisions about treatment should always be made on a case by case basis through honest discussion between doctors, patients and their families that factor in the risks, benefits, and people’s wishes. There is no reason to abandon this long-established good practice now; in fact the current health emergency makes it more critical than ever that we keep it.”

Earlier this week The Detail website published two in-depth articles examining these and similar concerns.

It reported that no information is available on the number of people who had completed DNACPR forms and later died from Covid-19.

It also quotes the Commissioner for Older People for Northern Ireland (COPNI), Eddie Lynch, confirming that he was conscious of “a gap in protection” as Covid-19 began spreading.

In Great Britain, The Equality Act 2010 directs that all age-based NHS and social care practices must be objectively justified if challenged, but the Act does not apply in Northern Ireland.

Mr Lynch said he wants to see the legislative gap filled “at the earliest opportunity following the pandemic”,

When the News Letter asked the NI Department of Health if the department had details on the number of Covid-19 victims who had signed DNACPR forms, a spokeswoman said: “There are currently no plans to collate data on the completion of DNACPR forms.”

Commenting on the concerns that some patients felt pressured to sign one of the forms, the DoH said current guidelines recognise “the need to respect patient autonomy and the need for sensitivity”.

A DoH spokeswoman said: “Advice issued by the GMC in 2010 and the BMA/RCN/Resuscitation Council (most recently in 2016) addresses decisions not to commence cardio-pulmonary resuscitation in their totality, particularly recognising the need to respect patient autonomy and the need for sensitivity.

“This involves a discussion with the individual, their relatives or advocate if appropriate, adequately documented as part of an on-going care plan, not the unsolicited issuing of forms.

“Where a patient lacks capacity, the clinician should consult the family to determine the patient’s views if known. In the absence of any expressed view, there should be a presumption that CPR should take place.”

The spokeswoman added: “Patients, or their representatives, are at liberty to seek the review of a DNACPR decision if they feel it inappropriate or they feel their views were not adequately sought or considered in the initial decision.”

“They also have recourse to the complaints process which, in the first instance should be to the practice or Trust.”

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