Prison service told to ensure ‘do not resuscitate’ decisions reflect 'consent' of prisoners
The Irish Prison Service has been told to ensure that ‘do not resuscitate’ decisions for prisoners reflect “the free and informed consent” of the persons involved following the death of an inmate at a Dublin prison.The instruction came from the Office of the Inspector of Prisons (OIP) after an investigation into the circumstances surrounding the death of the 63-year-old prisoner in question. The prisoner, who was an inmate at Mountjoy Prison, died in hospital in January 2023.He had been serving a four-year and three-month sentence from February 2022. The man had begun his sentence while suffering from multiple ailments, including liver disease and cellulitis, while he had also been in need of a knee replacement at the time of his death.His death was the first which had required an investigation by the OIP in 2023. In total, 24 inmates passed away while serving sentences within the prison system that same year.The death in custody investigation report said while the man’s family had no issues with the standard of care he had received while in prison, following his death his sister said she had been unaware of quite how poor his prognosis had been when entering custody. She requested that the OIP team investigating the circumstances provide a timeline of events that led to the man’s passing.The prisoner experienced multiple health episodes requiring both extended hospitalisation and repeat consultations with prison doctors over the course of his 11 months in Mountjoy.Following one of these appointments at the Mater Hospital in Dublin on December 14, 2022, the Prison Healthcare Medical System (PHMS) noted on the man’s record that his discharge letter from the hospital stated a “decision for DNAR (do not attempt resuscitation) and not for transfer to ICU/HDU (intensive care/high dependency units) in case of deterioration”.Such a decision would prevent a doctor or nurse from performing CPR in an attempt to restart a patient’s heart following a cardiac event.At the time the PHMS did not record whether or not the prisoner had given his informed consent regarding that decision, with a nurse noting on the man’s record that she would discuss the issue with a doctor the following day “as this may need to be followed up on”.However, no further entries on the man’s log were made regarding the matter.At the same time senior officials within Mountjoy were seeking the man’s early release on compassionate grounds due to the gravity of his condition, though his file also noted that he was “still in relatively good form” and continued to attend classes within prison.The prisoner was hospitalised once more at the Mater on December 27, and then suffered a heart attack on January 4, 2023, which saw him placed on life support. He passed away the following day surrounded by his family.Having considered the circumstances surrounding the man’s death and the DNAR decision, the OIP recommended that prison staff should “take active steps” to verify that any prisoner returning from hospital with such a decision had given “free and informed consent” to that decision and that all information relating to the issue “should be fully documented" within the PHMS.
A spokesperson for the prison service said that it “acknowledges” the publication of a prisoner’s death in custody report.Regarding the recommendation concerning DNARs, the spokesperson said that “an action plan has been sent forward to the Inspector of Prisons and the Irish Prison Service continues to work towards its implementation”.
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