title: DNACPR ('do not attempt cardiopulmonary resuscitation') orders in patients with a fractured neck of femur who lack capacity.
abstract: Nationally, half of all deaths occur in hospital, with 94% having a 'do not attempt cardiopulmonary resuscitation' (DNACPR) notice in place at the time of death. Recent court rulings have raised the profile of practices surrounding DNACPR orders where patients lack capacity. Failure to consult with those close to the patient in relation to DNACPR decisions is a breach of the right to respect for private and family life under article 8 of the Human Rights Act. A report from 2016 found that those close to the patient were not consulted before one out of every five DNACPR orders are placed. We advocate addressing the issue of resuscitation in patients with a fractured neck of femur who are approaching the end of their lives. Where the patient lacks capacity, there is a legal duty to consult with those close to the patient where it is practicable and appropriate to do so. There must be a convincing and well evidenced reason to proceed without consultation, and the orthopaedic surgeon should exercise extreme caution before doing so.
authors.affiliation: University Hospitals of Morecambe Bay NHS Foundation Trust , UK.
authors.forename: D S
authors.initials: DS
authors.lastname: Hill
authors.affiliation: Hill Dickinson LLP, London , UK.
authors.forename: L
authors.initials: L
authors.lastname: Nazar
authors.affiliation: University Hospitals of Morecambe Bay NHS Foundation Trust , UK.
authors.forename: M
authors.initials: M
authors.lastname: Freudmann
mesh_terms: D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000150:complications*; D005190:Family; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D019727:Proxy; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D006113:United Kingdom
keywords: Capacity; DNACPR; Decision; Fractured neck of femur; Legal