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DNARs, critical care and your rights

Some people with long term health conditions have had letters or calls from their doctors about signing Do Not Attempt Resuscitation (DNAR or DNR) documents. It's important to remember having MS in itself does not mean you’ll be denied critical care.

We completely understand that the idea of being denied treatment is extremely worrying for anyone.

The NHS has been preparing for a scenario during the peak of the pandemic where it doesn’t have enough critical care for everyone who could benefit (in Covid-19 "critical care" usually means ventilators - machines that help people breathe). It's important to say that in general hospitals have spare ventilators right now, so we are not living in this worst-case scenario that the NHS has been preparing for.

Access to NHS ventilators for people with MS

Early evidence also indicates that, as with the general population, the vast majority of people with MS who are diagnosed with Covid-19 recover without becoming ill enough to potentially require a ventilator.

Ventilators are only used as a last resort because ventilation is an invasive, high-risk procedure and the odds of surviving it are not very good, especially for people who are in poor health to begin with. This means that, where a ventilator is an option, some people choose not to undergo the procedure and instead choose palliative care and spending time with loved ones.

It would be completely inappropriate for anyone to say, or even imply, that having MS in itself means you should not be eligible for ventilation. The only criteria that should ever be applied to a critical care decision is the chances that a given person will recover and return to a good quality of life – and many people with MS will have a strong likelihood of recovery.

Do Not Attempt Resuscitation (DNAR) orders

With that said, some doctors are encouraging people to think about what they would hypothetically prefer if they were to become ill enough to require a ventilator, rather than have to take this kind of decision unprepared in an emergency room (or have their family decide for them if not conscious).

Having had a chance to think it over and discuss with your loved ones, some people decide to sign a document called a “Do Not Attempt Resuscitation” (DNAR) order, stating that they would prefer not to be offered resuscitation (in the context of Covid-19, usually via a mechanical ventilator).

We would emphasise that you have the right to sign a DNAR, never an obligation - you should not be pressured to sign a DNAR in any circumstances. You equally have the right to make clear that you definitely want critical care if it is available – although, as with most of emergency medicine, doctors have the right to make the final decision.

Critical care for people with long-term conditions

The British Medical Association (BMA) has issued a statement about how their guidance on critical care should be applied to people with long-term conditions and disabilities. They say:

"Under our guidance, the fact that someone is above a particular age, or that they have an existing medical condition is not, in itself, a factor that should be used to determine access to intensive treatment. Similarly, someone with a disability should not have that disability used by itself as a reason to withhold treatments, unless it is associated with worse outcomes and a lower chance of survival. A decision to exclude from treatment everyone above a particular age, or with a disability, would be both unacceptable and illegal."

You can read the BMA statement in full on their website. And there is information on advance decisions to refuse treatment on the NHS website.

You may also be interested in information from the law firm Leigh Day, which discusses some of the legal and moral questions around DNARs generally.