Decisions about living and dying well during COVID-19

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Decisions about living and dying well during COVID-19

In March 2021 the Care Quality Commission (CQC) reported that they had recently checked services like hospitals and care homes to make sure they were giving good care to people, particularly those who might be close to the end of their life. https://www.cqc.org.uk/publications/themed-work/review-do-not-attempt-cardiopulmonary-resuscitation-decisions-during-covid

They emphasised that there are important decisions to make about how we want to be cared for should we become seriously ill or seem near to the end of life. These decisions need to involve conversations with each person concerned, our family, carers, doctors, and those holding legal power of attorney for our health, about the kind of care we would want in this situation, whether we would want to go to hospital, or if we would want to ask not to have certain types of treatment.

The CQC acknowledges these are not easy matters to think and talk about, but we should all ideally talk about what we would want to happen, before we become seriously ill. On this website, on the Talking Points page, you will see a helpful relevant link https://compassionindying.org.uk/library/planning-ahead-treatment-care/ which offers advice on advanced care planning.

Our Resources page has articles fully addressing this matter such as 'Have conversations about Advanced Care Planning', ‘Do you want to be resuscitated?’ and ‘Coronavirus: Doctors urge talking about dying’.

CPR treatment

The CQC report goes on to say the discussions mentioned above can help doctors make important decisions about emergency care and treatment, should we be unable to take these decisions ourselves. One of these decisions is whether doctors should try a treatment called ‘cardiopulmonary resuscitation’, ‘CPR’ for short. CPR is a treatment used in emergencies and aims to restart our heart if our heart stops beating or we stop breathing.

CPR would only be used in very serious situations and is not successful that often. It can sometimes do more harm than good. We can agree to a ‘do not resuscitate decision’, which means we decide we do not want doctors to use CPR to attempt to restart our heart. This decision would be recorded as DNACPR.

The government asked CQC to talk to doctors and people who oversee the running of hospitals and care homes, as well as other people who use care services and their families. This is so they can find out how decisions were made about DNACPRs in 2020, when so many of us became ill with the new disease caused by coronavirus. This is because the CQC was worried that people were not always consulted about their DNACPR decisions. Their concern was that DNACPRs were possibly being decided for groups of people rather than for each person individually. This enquiry will include increasing people’s awareness of care planning for living and dying well. Health and care services must make sure that people are included in decisions about DNACPR as part of their care planning, and that staff have enough time and training to do this. CQC will check that this happens.

All of us should think and talk about how we would want to be supported and what matters most to us, should we become seriously ill or approach the end of life.

Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care, CQC very helpfully says: "We need to capitalise on this momentum to ensure conversations about advance care planning and DNACPR decisions are high on everyone’s agenda, and that people are given better information about these decisions at the time the conversations take place.

Lastly, everyone should think and talk about how they would want to be supported and what matters most to them if they became seriously ill or approached the end of their life. It involves talking and exploring options about the type of support and care people would like to receive.

If you have questions or concerns about the use of DNACPR or wider care for yourself or someone close to you, please discuss these with the health and care professionals involved".

After reading this article, you may feel challenged, uncomfortable, and unsure of any actions you should take. On our ‘Read online’ page on this website, there are chapters that take you more deeply into the whole area of our mortality. Chapters particularly relevant are 3, ‘Difficult Decisions’ and 4, 'Talking about dying, when, where and how'. We so hope these are helpful.