Lasting Power of Attorney (LPA)

Check if the patient has an LPA (see the relevant section with the ‘During Life’ section of the website’). If so, and the patient has lost mental capacity, the appointed Attorneys may have authority to make decisions about giving or refusing consent to life-sustaining treatment.

Do Not Attempt Resuscitation – DNAR

Your loved one may reach a stage when the doctors suggest that a DNAR form is put in place.

DNAR means that if your loved one’s heart or breathing stops, their healthcare team will not try to restart it.

DNAR is a medical treatment decision that can be made by your doctor even if you do not agree. If you disagree with a DNAR decision that a doctor has made, you can ask for a second opinion and a review. Ultimately, you would have to apply to the High Court for an injunction if you wished to challenge the decision; you should seek formal legal advice in this regard.

More information about DNAR can be found here on the NHS website:-

https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/

End of life care at Home

PRACTICAL TIP:- Given the strict rules governing the issue of an MCCD death certificate (see below), it is imperative that the patient’s GP does attend them during any end of life care period at home. This can be by video-call. Ideally, the GP should see the patient at least once within every 28 day period. This will enable the GP to issue the MCCD and minimise any delays.

PRACTICAL TIP:- where your loved one is at home on end of life care, you can ask a doctor (GP or discharging hospital doctor) to sign a ‘Statement of Intent’ to inform out of hours services that your relative/friend is expected to die within the next few hours or days. It is usually valid for around 14 days. It confirms that a Medical Certificate of Cause of Death will be completed by the doctor that has signed the Statement. In some cases, the doctors are not able to complete a Statement of Intent if your loved one’s condition is reportable to the Coroner. However, where it is in place and death occurs, the Paramedics can notify the Police that it was an expected death thereby avoiding the need for the Police to attend the home. The body can then be taken to the Mosque or funeral director’s mortuary instead of the hospital mortuary.

End of life care at Hospital

I would recommend that you make contact with the Hospital Muslim Chaplain.

PRACTICAL TIP:– if death is expected imminently, the Medical Examiner may agree to review the notes and discuss the matter with the treating doctor before death occurs. This can minimise any delays with the MCCD after death.

The National Medical Examiner’s Good Practice Series No.2 published in April 2021 recommends that the Medical Examiner:-

“Engage with clinical colleagues, so that where death is imminent, attending teams are aware they can discuss the case with the medical examiner or officer before death to prepare the way for release of the body if death occurs out of hours. The team responsible for the patient’s care should record clear instructions for those on duty when death occurs to minimise distress to the family. Involvement of the medical examiner in natural and expected deaths will allow the body to be released to the family in line with their wishes while awaiting the MCCD the following day”.