Acton Institute Powerblog

NHS staff told ‘do not resuscitate’ COVID-19 patients with learning disabilities

(AP Images. Photo by Vuk Valcic / SOPA Images/Sipa USA)(Sipa via AP Images)

After a year-long legal battle, a British hospital apologized for placing 51-year-old Andrew Waters under a “Do Not Resuscitate” order without his family’s consent during his 2011 hospital stay, because he suffered from Down syndrome and “learning difficulties.” A disturbing news report shows that doctors have placed blanket “Do Not Resuscitate” (DNR) orders against people with learning disabilities in order to mitigate an NHS shortage of medical supplies during the COVID-19 pandemic.

Mencap, a group that advocates for those with cognitive conditions, told The Guardian that doctors with the UK’s National Health Service instructed hospital staff to do nothing if COVID-19 patients with learning disabilities went into cardiac arrest; their treatment order was to let the patients die. Usually, DNR orders only apply to those too weak for CPR to help. However, that did not apply to the vast majority of these DNR orders, which were inserted into medical files without the knowledge or consent of the patients or their families – sometimes without consulting with other staff.

These stealth DNR orders are “unexploded landmines,” said Jackie O’Sullivan, an advocate for those with learning disabilities, because “you don’t know whether you’ve got one until you need the treatment.”

The scale is not yet known, but one organization that offers care to people with learning disabilities said it received more “unlawful” DNR orders last April than it did in a typical year. “Making an advance decision not to administer CPR if a person’s heart stops, solely because they have a learning disability, is not only illegal, it is an outrage,” said Julie Bass, CEO of Turning Point (not to be confused with the conservative activist group).

While a government report is due out shortly, “inappropriate” DNR orders caused avoidable deaths last year, according to the Care Quality Commission.

The DNRs may explain why COVID-19 caused 65% of all deaths among people with cognitive issues since the UK’s second lockdown began. People with learning disabilities are 6.3 times more likely to die of COVID-19, and young people in the 18-to-34 demographic are 30 times more likely to lose their lives to the virus, according to a study released last November by Public Health England, a government agency.

Statistics show women with learning disabilities – who already die 28 years younger than their counterparts – suffer the worst health outcomes under the NHS’s COVID-19 regime.

Targeting those who are already at risk has drawn strong rebuke from religious and moral authorities.

“This is eugenics thinking: pure, simple, and crass – a denial of human exceptionalism and the equal moral worth of every person,” blogged Wesley J. Smith, a contributor to Religion & Liberty, at National Review.

The Roman Catholic bishops of England and Wales said they were “distressed” by the orders, which violated the “God-given dignity” of all human life “from the moment of conception until natural death.” Jewish charities also noted the “halachic implication” of healthcare decisions.

“Why have the vulnerable been targeted when they should be protected?” asked Rev. Patrick Pullicino, a neurologist subsequently ordained a Roman Catholic priest. “We need to find out what has gone wrong in the NHS and why this is happening.”

Yet he told the Catholic News Agency the proximate reason: The glut of DNRs against people with learning disabilities “directly stems from the COVID-19 critical care referral algorithm, which mentions those with learning disabilities or autism with the under 65-year-olds as being potentially frail and therefore not in line for ITU [Intensive Care Unit] care.”

A nameless, faceless algorithm – and the “unlawful” actions of some doctors – condemned innocent people to an avoidable death in order to conserve the nation’s always-strained healthcare resources.

Concerns about finite supplies and treatments span the globe. The Trump administration’s Office for Civil Rights forced Alabama to rescind an order withholding ventilators from coronavirus patients with “profound mental retardation.” Yet while the U.S. system quickly rebounded, the NHS has only moved out of the highest possible threat rating, Level 5, on Thursday.

Rationing is the inevitable outcome of a national or single-payer healthcare system. Socialized medicine must grapple with patients’ infinite demand of the limited supply of doctors and medicine. Artificial delays in scheduling “elective” surgeries, long emergency room wait times, and limited treatment options follow. Its supporters cry the system is “underfunded,” yet no amount of money can fund infinity. Thus, the system cuts off services to the most vulnerable, the least powerful, and most in need of help – the poor, elderly, and disabled. No wonder the top source of government bribery in Western Europe takes place within national healthcare systems, according to Transparency International.

Thanks to these economic realities, the NHS is perpetually strained-at-the-seams. The British Red Cross said that NHS care amounted to a “humanitarian crisis” in January 2018. Each “winter crisis” seems worse than the last, pre-COVID. Despite its mediocre-to-poor performance, the NHS retains a near-religious status among the British people. Some NHS doctors now believe their duties confer the divine prerogative of choosing some lives over others.

“If true, heads should roll!” wrote Smith of the latest NHS rationing scandal.

Yet the British government seems resistant to offer any relief. Parliament rejected a petition to “change the ‘do not resuscitate’ orders on patients with learning difficulties,” because “it’s not clear what the petition is asking the UK Government or Parliament to do.” In the past, the NHS has used the courts to enforce decrees that end patients’ lives. The single-payer system sued and won a court injunction forcing a young Catholic woman with learning disabilities to have an abortion, although the order was thankfully overturned.

The NHS not only denied all care to Alfie Evans and Charlie Gard but then sued to prevent their parents from seeking healthcare for their own children elsewhere – even from no-cost providers personally arranged by Pope Francis. Control of healthcare gave the government an aura of omniscience capable of dictating the best life-and-death circumstances of all 67 million Britons.

The hesitancy to act on this scandal, which has been public since last spring, is all the more perplexing, because it violates official government policy. UK Health Secretary Matt Hancock and NHS leaders in England repeatedly instructed doctors not to place blanket DNRs in patients’ files, insisting all diagnoses be made on a case-by-case basis.

The NHS opposed these orders; nevertheless, they have pervaded the UK for nearly a year. The NHS may operate on the best of intentions, yet the economic incentives and realities of scarcity produce rationing that better reflects a culture of death. Life-denying directives are handed down with little transparency and even less legal recourse.

As plans for greater nationalization of U.S. healthcare percolate through the Capitol, people on both sides of the Atlantic would do well to heed these lessons.

Under a national healthcare system, we all run the risk of becoming Andrew Waters.

Rev. Ben Johnson

Rev. Ben Johnson is Executive Editor of the Acton Institute's flagship journal Religion & Liberty and edits its transatlantic website.