PART 7: End-of-Life Ethics, DNACPR, ReSPECT & The Coroner

PART 7: End-of-Life Ethics, DNACPR, ReSPECT & The Coroner

• Core Dilemma: Handling family conflict over DNACPR decisions and identifying deaths that legally require referral to HM Coroner.
• DNACPR & ReSPECT Law (Burke, Tracey [2014] & Winspear [2015]): DNACPR is a clinical medical futility decision, not a family vote—relatives never "sign" a DNACPR. However, under Article 8 ECHR and MCA s.4(7), clinicians have a mandatory legal duty to inform capacitous patients (Tracey, unless doing so causes actual physical/psychological harm, not mere distress) and consult families of incapacitous patients (Winspear).
• Reporting Deaths to HM Coroner ("UNSAFE CUSTODY"): Under the Notification of Deaths Regulations 2019 (and Sept 2024 Medical Examiner reforms), report all deaths involving: Unknown cause, Neglect, Suicide/overdose/poisoning, Accident/trauma/violence, Failed/complicated medical procedure, Employment/industrial disease, or CUSTODY/state detention.
• MRCEM/FRCEM Exam Trap: (1) A DNACPR form applies ONLY to CPR—it never withholds antibiotics, IV fluids, analgesia, or NIV. (2) Any death linked to a traumatic fall (e.g., an elderly patient dying of pneumonia 3 weeks after a fractured neck of femur) must be reported to the Coroner, as must any natural death occurring while detained under the Mental Health Act or in prison.