Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Senator for raising this very important issue. He is definitely right that the conversation needs to be had. I am delighted to hear the person involved, who brought it to the his attention, has recovered.

The HSE's national quality improvement team in the office of the chief clinical officer prepared and published guidance on this important matter earlier this year, with specific reference to the Covid-19 pandemic. This guidance is for healthcare workers regarding advance care planning and cardiopulmonary resuscitation decision-making, including making DNR decisions. The guidance is applicable to all care environments where services are provided for and on behalf of the HSE, including acute hospitals, the ambulance service, community hospitals, residential care settings, general practice and home care.

Section 4 of the HSE national consent policy, which has been in place since 2013, on DNAR orders, and the HSE guidance regarding cardiopulmonary resuscitation and DNAR decision making during the Covid-19 pandemic, apply to all HSE and HSE funded agencies and give explicit guidance on when and how a DNAR decision can be made. Part 4 of the HSE's national consent policy has been in place since 2013. However, DNAR clinical decisions had been in place for many years before this, guided by the Irish Medical Council's code of professional conduct and ethics. The HSE guidance regarding cardiopulmonary resuscitation and DNAR decision-making during the Covid-19 pandemic was developed in May 2020. The purpose of the guidance is to affirm existing good clinical practice and guidelines regarding CPR and DNAR. The guidance did not change any of the principles addressed in the HSE's national consent policy of 2019.

The development of the HSE National Consent Policy 2013 included service user representation and there was wide consultation on this policy, which also included a large number of service user groups and individuals. The national consent policy states with respect to individual DNAR clinical decisions that where a person has capacity the clinical lead should discuss options with the person in the first instance. This is very important. If the person is unable to participate in discussions after being given appropriate supports to do so, discussions with those close to them can provide insight into their previously expressed goals and preferences. However, the role of those close to the person is not to make the final decision regarding CPR or to consent to a DNAR decision as this authority does not exist under current law. The purpose of these discussions is to help the senior clinical decision maker make the most appropriate decision, having regard to the goal and preference of the person.

Decisions about CPR must always be made on the basis of an individual assessment of each individual case and not, for example, solely on the basis of age or disability. Any distinction based solely on such criteria is discriminatory and contrary to human rights principles. DNAR decisions are made in the context of the person's overall goals and preferences for treatment and care as well as the likelihood of success and the potential risks and harms.