DNR Orders - Learning Disabilities Is Not an Acceptable Rationale

The recently released 3rd annual report of the English Learning Disabilities Mortality Review (LeDeR) programme shows 19 reviews reporting the term "learning disabilities" or "Down’s syndrome" was given as the rationale for a DNR order.

The report recommends:

1. The Department of Health and Social Care, working with a range of agencies and the Royal Colleges to issue guidance for doctors that ‘learning disabilities’ should never be an acceptable rationale for a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order . . . .
2. Medical Examiners to be asked to raise and discuss with clinicians any instances of unconscious bias they or families identify e.g. in recording ‘learning disabilities’ as the rationale for DNACPR orders . . . .
3. The Care Quality Commission to be asked to identify and review DNACPR orders and Treatment Escalation Personal Plans relating to people with learning disabilities at inspection visits. Any issues identified should be raised with the provider for action and resolution.