Addenbrooke&#39;s and Andrew Lansley sued over &#39;do not resuscitate&#39; rule

Cambridge hospital and Department of Health accused of acting unlawfully by husband of woman who died

The husband of a woman who died in one of Britain's best-known hospitals is taking its management and the health secretary Andrew Lansley to court, alleging an illegal use of "do not resuscitate" orders.

David Tracey claims doctors at Addenbrooke's hospital, Cambridge, twice put such orders in his wife's medical notes, cancelling the first after she objected to it only to put in a second three days later without her consent or any discussion with her.

Tracey alleges the hospital's actions deprived his 63-year-old wife Janet of the right to life and subjected her to degrading treatment, while he was denied respect for his personal and family life.

He is also seeking to force the coalition government to draw up a policy for England on the use of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) instructions, and claims the present system of local policies is open to abuse.

The case is likely to ignite a public debate over whether patients should have the final choice over their life and death, or whether doctors ultimately "know best" on when such treatment might be futile.

Thousands of "do not resuscitate" instructions are added to medical notes each year. There is UK-wide guidance for health professionals, but the NHS in England leaves official policy to local health trusts, although there are moves at regional level to harmonise approaches. Scotland has a countrywide policy.

Solicitors have lodged a claim for David Tracey and the estate of his wife Janet, the manager of Trent Lodge care home for older people in Enfield, north London, with the high court, alleging breaches of the 1998 Human Rights Act.

It wants a judicial review of the actions of the Cambridge University Hospitals NHS trust which is responsible for Addenbrooke's, and the Department of Health, both of which deny they have acted unlawfully.

In February Janet Tracey, who had four daughters and seven grandchildren and had recently been diagnosed with terminal lung cancer, was admitted to Addenbrooke's after breaking her neck in a car accident. She died 16 days later.

Her husband alleges the trust acted illegally by not having an appropriate policy on resuscitation decisions ? and that the health secretary had not issued any "clear policy or guidance" which told patients and their families of their "rights and legitimate expectations".

David Tracey claims the lack of a standard policy is liable to create a system that is "arbitrary, variable between hospitals and open to abuse" ? and, in the case of his wife, failed to offer "a minimum degree of protection" of her human rights.

Tracey said: "My wife cared for the elderly all her life and her treatment at Addenbrooke's caused unnecessary suffering to her, our daughters and me. She would have taken great pride in seeking a change to the system which would mean future patients and their families are not forced to endure the same experience."

Alison Noeland, one of her daughters, said: "We believe mum's experience is a consequence of the lack of clear policy on decisions relating to end-of-life care. A clear and national policy is needed. It should not be the case that there is a different policy from area to area. This just does not make sense."

Noeland and her sister, Kate Masters, have also made formal complaints to the hospital. But the hospital has told them it will not respond to these until the legal action is concluded.

Tracey's solicitor Merry Varney, of Leigh Day & Co, said: "The use of DNACPR orders are widespread, yet patients and their families seem often to be unaware of the decision-making procedures, the meaning of the term and even their use.

"The fact that under current policy, treatment with the potential to sustain life can be withheld without the consent or knowledge of a fully capacitated patient raises real risks of gross violations of an individual's basic human rights, and appears perverse considering the current law regarding assisted suicide and the right to die.

"Janet's medical notes clearly stated that prior to her death she was unaware of the DNACPR on her file, which reinforces that the current system is open to abuse and can disregard patient choice. We hope to bring an end to this and seek coherent national guidance giving full information on a patient's right to choose and be informed, and what to do if a dispute arises."

Addenbrooke's hospital told the Guardian: "We do not agree with the account given by the family, but we cannot debate the issues involved because we are subject to ongoing judicial review proceedings.

"Our clinicians followed the DNACPR policy, which remains in place." The hospital sent the Guardian a copy of its policy, but said it did not have a patient information leaflet.

The Department of Health said in a statement: "Decisions on Do Not Attempt Cardio-Pulmonary Resuscitation must be clinically appropriate for the individual involved, weighing up the possible benefits of CPR against any burdens or risks associated with the treatment.

"Because clinical judgement is so important in these decisions, it's our view that guidance provided by a responsible body of professional opinion, based on direct experience of the complexity and sensitivity of these circumstances, is more appropriate than the setting of national guidance by the department."

James Meikle

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