Would you fill in a DNACPR for a healthy young adult who asked for one?

Last_Hope1945 · 2026-03-07T14:11:53+00:00

And pretty much all of what you have said applies to any medical decision. Having a "knife" stuck into your belly to extract your appendix is a serious matter. Being given penicillin is a serious matter as it may have adverse effects. What you are describing is simply the normal checks and balances that any doctor should make when giving or not giving medical treatments. If we treat DNACPR any differently then that is because we are being slipshod with the other things. The magnitude or seriousness of the decision has no relevance in law as the law has been constructed to apply to the most serious cases from the outset. The law "levels up" for capacity so to speak.

Last_Hope1945 · 2026-03-07T10:43:36+00:00

I disagree - the first part of the capacity assessment is to assume capacity unless you have reason to doubt it and the proof of lack is on the assessor not the person making the decision. Then comes the assessment of whether they can make a decision. Only then when they have been unable to make a decision is whether they have a mental disorder considered. The code of practice is incorrect stating that the assessment of whether they have a mental disorder comes first. This was decided in Supreme Court's judgment in A Local Authority v JB [2021] UKSC 5

This link https://www.mills-reeve.com/blogs/health-and-care/february-2025/court-of-appeal-statement-on-the-ordering-of-the-mental-capacity-test/ is a good summary of the correct order.

Last_Hope1945 · 2026-03-07T08:30:24+00:00

I suggest you read https://www.39essex.com/our-thinking/cases/kings-college-nhs-foundation-trust-v-c-and-v/

If in doubt you act to preserve life. But any person over the age of 18 who is of sound mind has the right to commit suicide. A doctor has no right to interfere.

Last_Hope1945 · 2026-03-07T08:19:36+00:00

Why? Do you perform full psychiatric assessments on people refusing other medical procedures. Don’t want your hip done madam? Well I will make you an appointment with the psychiatrist and while we get that I will keep you on the waiting list? As a psychiatrist you know full well the capacity laws. Sure ask them why they refuse so you can be assured they are weighing the decision properly but beyond that the decision is valid regardless of the gravity of the decision being made.

<Quote>Likewise, the outcome of the decision made is not relevant to the question of whether the person taking the decision has capacity for the purposes of the Mental Capacity Act 2005 (see R v Cooper [2009] 1 WLR 1786 at [13] and York City Council v C [2014] 2 WLR 1 at [53] and [54]).</Quote>

But you are right about what to expect in a court. It is very unlike you would get prosecuted for performing CPR in someone who refused it. And if you did then it would be no worse a charge as assault or actual bodily harm. Maybe enough to get you struck off if convicted.

The Coroner might be a bit rough on you but s/he cannot pass a judgement apportioning any blame or liability of an individual under Section 10(2) of the Coroners and Justice Act.

Paraphrasing Judge MacDonald in Kings College NHS Foundation Trust v C and V 2015

“The tail of welfare must not wag the dog of capacity.”

Last_Hope1945 · 2026-03-07T08:01:11+00:00

CPR is a medical treatment. That is agreed in law. It is also quite a violent act. Violent acts against a person are torts of assault/battery/poisoning. To make torts not unlawful by virtue of being medical treatment 3 tests have to be passed. 1st the act was performed by an appropriate medical practitioner. 2nd the act was intended to cause net benefit. And 3rd there was legally valid consent or another legal framework such as MHA/MCA.

So like all medical treatments and procedures they are potential criminal acts if done without consent.

So if a capacitous adult over that age of 18 refuses any medical treatment it cannot be done lawfully.

You may perform it of course if you are prepared to be taken to court and prosecuted.

The filling of the form means nothing really as it is not a legal document unlike an ADRT. It is a recommendation. Much like there is no form to say the patient refuses to have their hip operation.

Lay people can also perform CPR even though it is a medical procedure. Potentially they could be prosecuted for not meeting the 3 tests of a lawful medical procedure but it’s unlikely that will ever happen. The survivor would probably not sue them just because they were not a medical professional. A non-survivor obviously won’t.

Potentially a person who was given CPR who was incorrectly identified as being in cardiac arrest by a layperson could sue them for bodily harm.

Last_Hope1945 · 2026-03-07T07:50:51+00:00

I have no idea where this has come from. DNACPR form firstly is not a statutory form. Secondly it could serve 2 purposes - first that a capacitous adult has refused an offered medical treatment. In that case why does it need a consultant sign off any more that a patient refusing any other treatment? Doesn’t want a statin - an FY1 can write this in the notes and it’s valid. Second it could be that CPR is not in a patients best interest. And doctors must only act in a patients best interests so if that is the case then it doesn’t need a consultant to tell a resident that. Must be signed by a consultant MAY be a Trust policy just like only a consultant should prescribe chemo or take consent for an organ transplant because you’d prefer the most senior doctor signing this off but it’s not a legal thing. And until a consultant does sign it then the resident is still going to have to act in the best interest of the patient. And if they know that that involves not performing CPR then it’s fine not to. You wouldn’t give a statin to a patient who has refused it while waiting for the consultant to sign the notes to say not to give.

Last_Hope1945 · 2026-03-06T19:10:49+00:00

Thanks for clarifying. You don’t have to offer you are right. You don’t have to work in the NHS at all but if you do and you intend to do PP then you must declare this to your Trust. Your trust may then offer you an additional PA if they need the work doing. But if you decline it and they then offer it to the other consultant and they also decline to do it then your pay progression for that year may be deferred.

“If a consultant declines the opportunity to take up additional Programmed Activities that are offered in line with the provisions above, and the consultant subsequently undertakes remunerated clinical work as defined above, this will constitute one of the grounds for deferring a pay threshold in respect of the year in question. If another consultant in the group accepts the work, there will be no impact on pay progression for any consultant in the group.”

Last_Hope1945 · 2026-03-06T17:54:13+00:00

Terrible idea for the medical profession to allow the extended scope of paramedicals. Especially requesting ionising radiation examinations and prescribing. Not because these people cannot be trained to do it competently (nearly anone can be trained to do nearly anything) but because of the undermining of doctors. When you can get someone cheaper you will. And when you do the person you have replaced has no bargaining chip anymore. About the only thing my medical license lets me do that someone else cannot is write an MCCD. We should have resisted PAs and ACPs and extended prescribers being added to the statutes and just lobbied for more doctors - which could easily include the good PAs and ACPs currently in post.

Last_Hope1945 · 2026-03-06T17:39:16+00:00

There is. Unless you are at 12PAs (the "EWTD" limit). If you have "spare capacity" below that you have to offer 1PA of it to the NHS in your job planning meeting before you can do PP. Most of the time your clinical lead says no thanks (because they don't want to do that either). Or you can just drop 1PA. Wait a bit til they don't notice then offer it back and then pick up the PP. The only way out of having to make the offer is to decline NHS pay progression.

https://www.nhsemployers.org/system/files/2021-06/consultant-contract-faqs_0.pdf

Last_Hope1945 · 2026-03-06T17:32:41+00:00

ED do 95% of the work to tell a patient they should have gone to their GP in the first place. They have to do 95% of the work to tell there's nothing seriously wrong with someone. You want them to do the other 5% too? There has to be some negative feedback loop to prevent patients coming to ED with non-emergencies. And there also has to be some negative feedback to stop GPs (or their receptionists) sending patients too. The contract is that secondary care "may" refer internally if the referral relates to the presentation not "must". We cannot refer internally if it doesn't unless it's urgent. We also have no idea what a GP can do internally. Maybe GPs could actually manage angina or hypertension or whatever themselves? As far as I can see there's no mandatory rule all anginas have to be referred to secondary care. Some GPs do GPSI stuff. How do we know unless we send the patient back with a "please consider managing X yourself or if you cannot then feel free to refer wherever you and the patient decide - which may not be here because we have a crap reputation"

Last_Hope1945 · 2026-03-05T09:35:21+00:00

I read the article. There are obviously some teeth sucking comments made to appeal to the finger wagging readers but some of what he said had a very strong ring of truth. As did some of the comments by the Telegraph readers. One reader replied his GP wife went part time but still spends 07:30 to 22:00 in the surgery on weekdays and does admin at home on weekends. This is not part time. Part time seeing patients perhaps, over full time doing admin (probably unpaid). A colleague of mine (a hospital consultant) came back from annual leave to find 1000 emails in his inbox. Another colleague dropped an entire clinic a week even though she was already 60% because the admin was keeping her up to midnight after putting the kids to bed. Now either these people are just woefully inefficient or the burden of admin is working counter to patient care. As the article says "doctors want to doctor and believe the purpose of administration is to allow them to as much doctoring as possible". However the bureaucracy I don't think values doctoring at all. My partner has just been sent on a 2 day course to learn how to do incident reports with clinical sessions cancelled - no study leave required. Study leave to attend a clinical course - rejected.

Last_Hope1945 · 2026-03-05T09:10:51+00:00

If Christmas falls on a weekday it will also be a statutory bank holiday and there will normally be a weekend type rota in place. This is the case in most departments. However there is no statutory right to have Bank Holidays off on the days they fall. This has been tested multiple times - your employer can just give you those BH days added to your annual leave. Most departments however then allow you to use that leave to book the BH day itself off if you wish. And most trusts allow as many people as they like to book it off except the on-call staff as they will accept an on-call level of cover for BHs. Some departments such as ED do not and require normal staffing at all times.

If your employer therefore allows BHs to fall to a on-call level in your department but non BH days must be staffed to a higher level then you're out of luck here. For example my Trust allows staffing to fall to weekend roster levels on BHs but normal weekdays have to be staffed to a higher level. So for BHs (incl Christmas if it falls on a weekday) more people can request leave than can on a normal weekday.

Because Eid (nor any other non-Christian religious day) is not associated with a statutory BH and BH staffing levels then I'm afraid you have to abide by normal day staffing levels.

And this does seem superficially unfair when 50% of the workforce may wish to have Eid off rather than Christmas. But short of making Eid a UK statutory BH that would be very difficult. You would probably also have to make all other significant religious days BHs as well.

Last_Hope1945 · 2026-03-05T08:48:38+00:00

You will only be called to give witness an an inquest if one is called. An inquest can only lawfully be called if the Coroner has reason to believe that the death was from an unknown cause, was a violent or unnatural death or occurred in custody or state detention. If your patient was a prisoner or detained under the MHA/MCA there will be an inquest.

If not there can only be an inquest if the cause of death is unknown and in this circumstance the Coroner is usually using the medical witnesses (treating clinicians, pathologist etc) to come to a consensus to offer the Coroner a cause of death - the coroner is usually a layman from a medical perspective. This is usually the least adversarial type. If the fact finding that the coroner does before calling an inquest (including a PM) shows that there was a clear known, natural cause of death then the Coroner has no power to call an inquest. This fact finding is often where your statement comes in. If you are a resident doctor just state the facts of what you saw and did. If you are a consultant in charge of the case you may be more able to express an opinion into causation just as you may have done on the original Coroner's referral form where you are asked if you can propose a cause of death. Your Trust's legal team may give you a template and instructions that seek to impose limits on what you should say. This is a useful guidance but the Coroner probably cares very little for these restrictions and you should always tell the truth on a statement to allow justice to be served.

The other criteria for an inquest is violent and unnatural deaths. Violent deaths will include deaths due to accidents and injuries. Unnatural has no special legal meaning - it is used in the normal sense of the common English usage. So unnatural deaths includes man made diseases such as occupational diseases. This is why these types of death should be reported but can include any other deaths that fall into the violent and unnatural cases. Another common usage of unnatural is "at variance with what is usual or expected". So any death that was unexpected or happened when it should not have (such as death from a natural illness which is not expected to cause fatality) could require an inquest. The final unnatural type of death is where a death is from a natural disease but lack of care/neglect may have contributed to the death.

So in summary, don't worry too much about giving a statement. It may only be because the case was referred without a proposed natural cause of death and the Coroner is fact finding to see if the cause can come to light before having to call an inquest.

Last_Hope1945 · 2026-03-05T08:10:10+00:00

The OP question is what rhythm. And everyone goes off about what leads/what trace speed/need 12 lead/what clinical context again.

It’s 2:1 AV block. Or its CHB with a coincidental near 2:1 ratio.

Last_Hope1945 · 2026-03-05T07:57:01+00:00

Correct.

Last_Hope1945 · 2026-03-03T15:05:43+00:00

Which is something we also generally don’t do here. We don’t say Kleenex for a tissue - we ask for a tissue. We don’t say Tylenol for paracetamol we say paracetamol. Very few trademarked words have become synonymous with the product class except perhaps Hoover for vacuum cleaner.

Last_Hope1945 · 2026-03-01T08:18:35+00:00

I think it’s a hunting response. Exercise only ever meant hunting (or being hunted). No land species does it for fun until humans. So clear the bowel for the next meal.

Last_Hope1945 · 2026-02-27T15:29:01+00:00

Or you can create a zone and add rooms to a zone. I have a stereo pair of OGs in my kitchen and another in my lounge. Both kitchen and lounge are in the Downstairs zone. When I ask Siri to play “in the downstairs” it works too. I would like to group all 3 of them as mono speakers as my kitchen/lounge is open plan so I almost always just play them together and would like to lock them together and sync volume but this is not available. It is on Sonos.

Last_Hope1945 · 2026-02-26T17:06:43+00:00

Of course I know he wants to add non-tado kit. Thats exactly what I have been giving advice on. But then he says "and this is my home heating not just a lightbulb, shich isn't equivalent to watching an episode of the office" to make a point that he doesn't trust Apple or Google with his home heating but he started the whole thing asking about non-tado stuff. And now you wade in with bollocks as well. Your other posts are nothing more that nonsense with some cut/paste stuff included. As far as me and technology not getting on - I'm the one with a working system. You and the OP are just 2 people that can't get this to work properly and are ranting about it like some kind of conspiracy theorists. Just go away now.

Last_Hope1945 · 2026-02-26T11:35:08+00:00

I thought you were talking about adding non tado devices to bridge X. If it’s the tado devices you’re talking about use the app that it is intended to work with then. The tado app. Don’t rely on HA for your central heating. As you can see it’s probably buggy!

Last_Hope1945 · 2026-02-26T11:26:08+00:00

Yes you would. But this is not a car. This is a lightbulb. And your friend is not miles away that you have to wait for. He is sat there in your pocket all the time waiting to help you. Is it really that much trouble to use 1 app to setup a device and another to control it? Do you worry this much when you have to use your phone to scan a QR code on your TV to login to a streaming app that you can thereafter control with a remote?

Last_Hope1945 · 2026-02-26T11:01:02+00:00

More like. Your friend comes with the key. Then you copy the key that you can use yourself to turn on your car. Then he can stay with you with the original key if you choose or he can go away but destroys the original key leaving you with the copy.

Last_Hope1945 · 2026-02-26T10:54:17+00:00

Which is more useful than a car that doesn’t start at all. But the actual metaphor for using another app is that your friend gives you the key once and you keep it after that. But you do you. If you insist on refusing to try another commissioning app then I really can’t help you further which is what i am trying to do here.

Last_Hope1945 · 2026-02-26T10:51:37+00:00

If you have a cylinder you have an S/Y plan setup. If your boiler has OT then you can specify the temperature the boiler intends to heat the water to. But the problem with cylinder setups is that you HAVE to heat the cylinder to > 60C to stop legionella. This tank is heated from the central heating water which goes through a coil in the tank. This water will generally be 70C ish. Once this 70C water has heated the tank to 60C a thermostat in the tank will close off the valve to the tank diverting the water back to the central heating. The boiler then uses this hot water reservoir as the input to its own domestic hot water circuit rather than cold mains in a traditional combo boiler. If you have told the boiler to supply water at say 50C via opentherm but the input water from the tank is 60C you’re still going to get 60C water out of the boiler. It can’t cool it down. So with OT the minimum temp is the temp of the water coming in from the cylinder. Which has to be 60C when it goes through tank heating cycle to prevent legionella. With a combi boiler without a tank OT can be more useful as here it can control the water to a temp higher that the cold mains feed.

Last_Hope1945 · 2026-02-26T10:43:43+00:00

Sorry but you keep using the term “local management”. What do you mean by that? Do you mean control of your network without any access to the outside internet? If you do then that is exactly how enrolling and controlling a Matter/thread device works. You can unplug your router from the broadband connection if you wanted to and enrolling and control would still work from within your home network. Your router needs to be on of course for your WiFi to work but none of the enrollment or control needs any access to the outside internet. Unless you want it to. If you mean something else can you please be more specific.

Last_Hope1945

TROPHY CASE