QuestionSBA
QuestionChoice
Although the mother is upset about the lack of information that she has received it is still not acceptable to break patient-doctor confidentiality
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e
Tell the daughter that her mother does have a DNAR form and update her about her current care
QuestionChoice
Just because the daughter is the next of kin does not automatically mean that you can break patient-doctor confidentiality
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b
Tell the daughter that her mother does have a DNAR form as she is the next of kin
QuestionChoice
You should not break patient-doctor confidentiality by disclosing this information without the patient's permission. Instead you must ask the mother whether it is acceptable to relay this information to her daughter. Whilst a DNACPR is a medical decision, this antagonistic response is likely to create further tension
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d
Tell the daughter that their mother does have a DNAR form and explain that this is a medical decision and that her opinion will not change anything
QuestionChoice
This is the correct answer. The patient had capacity to make the decision about resuscitation, therefore, it is likely that she will have capacity to make the decision about whether to communicate this decision to her daughter. If you did not ask permission, you would be breaking patient-doctor confidentiality
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a
Check with the patient whether you can share this information with their daughter
QuestionChoice
This is the next best answer, as you cannot tell the daughter any information about her mother without her mother's consent
32905
c
Refuse to tell the daughter anything
QuestionComment
Loving the passive aggressive options
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# Overview

A Do Not Attempt CPR (DNACPR) decision can also be known as Do Not Attempt Resuscitation (DNAR)

A DNACPR decision provides information to healthcare professionals present on the best action to take if an individual suffers a cardiac arrest. A DNACPR is recorded, normally on a CPR Decision form, but is not in itself legally binding. This means that a doctor can overrule an existing DNACPR if they believe the circumstances do mean CPR would be in the patient's best interests.

A DNACPR can be made if cardiac or respiratory arrest is an expected part of the dying process, and either CPR will not be successful, or if CPR may be successful but the clinical outcomes (e.g. trauma and prognosis) mean it is not clinically appropriate. A patient with capacity may also refuse CPR.

# Best Interests 

Doctors can ultimately make the decision to put a DNACPR in place if it is in the patient's _best interests_, even if the patient themselves or their family disagrees. However, following a legal case in 2014, doctors must engage the patient and those close to them on the decision to make a DNACPR, and inform them if the decision to make a DNACPR order has occurred.

# R (Tracey) v Cambridge University Hospitals NHS Foundation Trust, 2014 

Janet Tracey died in Addenbrooke's Hospital in March 2011. She had been diagnosed with terminal lung cancer and had subsequently been involved in a car crash, in which she sustained a spinal injury. She required ventilation in the Intensive Care Unit (ICU), and after attempts to remove her from the ventilator were unsuccessful, a DNACPR notice was placed in her medical notes. Neither Janet Tracey nor her family were consulted about or informed of this decision.

The legal case concluded in favour of Tracey, finding that her Human Rights had been breached. The case acknowledged that the decision to put a DNACPR in place is ultimately a medical decision, and patients cannot demand treatment. But, the case did result in changes to DNACPR guidance:

Firstly, the decision to not tell a patient about a DNACPR notice can no longer be based on the fact that telling them would cause “distress”. Only if discussing a DNACPR order would cause the patient “physical or psychological harm”, can doctors justify not discussing it. In other circumstances, doctors are legally obliged to discuss a DNACPR order that has been made.

Secondly, it used to be the case that doctors were not obliged to discuss a DNACPR decision if the clinical decision has been made that CPR would be futile. This case amended this, making it a legal obligation for doctors to inform the patient that a DNACPR decision has been made, regardless of whether or not CPR could ever be successful (i.e. futility of CPR is justification for doctors making a best interests decision to make a DNACPR order - even if the patient wants CPR, but doctors are still legally obliged to inform the patient that a DNACPR order has been made).

A DNACPR decision relates only to CPR, and is not a refusal of any other treatment.
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DNACPR decisions
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Ethics and Law
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Always seek patient consent before disclosing medical information to relatives to uphold confidentiality and respect patient autonomy.
A 95-year-old female is an inpatient on the acute medical unit. She has been treated for a urinary tract infection with antibiotics and is due to be discharged home. Before discharge, the patient agreed with the consultant to complete a Do Not Attempt Resuscitation (DNAR) form. The patient had capacity to make this decision. The patient's daughter (her next of kin) visits the ward and demands to know whether or not her mother has a DNAR form. She is very upset because she says it has been so difficult to contact the ward to find out how her mother has been doing.

Which is the best next step for you, as the ward resident doctor, to take?
a