What was the service user's situation before working with Advocacy Focus?

James was 81 years of age and had been diagnosed with cancer. After his package of care had broken down at home, he was moved into residential care. Shortly afterwards his physical health suffered and he needed to stay in a hospital for a long time. He became increasingly dependent on other people. When he returned to the residential home his frailty and condition lead to a decision to consider a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order. This decision was to be made in his best interests under the Mental Capacity Act 2005 because James was deemed to lack capacity.

What did you do to help the service user?

We spoke with the decision-maker and carers at the home to find out why this decision was being made and reviewed related documentation to get an overview of his current presentation, physical health and circumstances. James had expressed his wish to implement a DNACPR.

A DNACPR is such an important decision that it was important to have an independent advocate to support him. The CPR procedure is very invasive and has a high risk of being unsuccessful. There is also a risk of having bruised or broken bones, loss of oxygen to the brain, and can be difficult to recover from, especially for elderly people with pre-existing physical health conditions. James was clear he did not want this procedure. If there had been concerns then we could have requested a second opinion. But James had his rights upheld and respected under the Mental Capacity Act (2005).

We provided James and the residential home with an easy read formatted Patient Information leaflet and asked carers to spend time with James to discuss his wishes, thoughts and feelings about the DNACPR in between our visits to find out if his views changed.

The first time we met James he appeared to understand the DNACPR decision and felt strongly that he ‘did not want Cardiopulmonary Resuscitation (CPR) under any circumstances and wanted to die in peace.’ But the second and third meetings we were unable to engage meaningful conversation with him as his mental health had deteriorated significantly.

Although his mental health had deteriorated, his physical health had significantly improved. James was mobile, had gained weight and become less frail. He was able to walk with our Advocate up and down the corridors. When they stopped to look out the window at a beautiful sunset - James beamed a great big smile.

We attended a 'Best Interest Meeting' with his GP (decision maker) and the care staff at the residential home. Our report, which highlighted his physical recovery, was taken into consideration by his GP the care staff. But his GP advised us that he was unlikely to recover from his mental condition. We discussed the benefits and burdens of CPR being carried out for James; should this ever be needed necessary. We highlighted that in our first meeting, James had made it clear he did not want to have CPR. His wish to ‘die in peace’ had weight in this important decision.

What was the outcome?

A DNACPR was implemented but would be reviewed in 12 months, because of James’s physical recovery. We had supported him through the process.

The DNACPR decision was not indefinite, as the decision-maker had originally considered it will be reviewed in 12 months. This provides additional safeguards for James and the opportunity to access advocacy again to help him understand his rights and express his views.