Muddying the waters of end of life decision-making: Tracey and the encroachment of law on clinical judgment

The decision in R (Tracey) v Cambridge University Hospital NHS Foundation Trust and Another [2014] EWCA Civ 822 to impose a legal obligation on clinicians to consult with patients before placing a 'Do Not Resuscitate' order in their notes, signals an important warning of the effects of allowing the law to encroach too heavily upon clinical judgment. While at first sight this may seem an obvious requirement, the decision has far-reaching implications, both in law and in clinical practice. Whether to consult the patient over a DNACPR is a matter of clinical judgment. By imbuing such a judgment with legal obligations, without elucidating what such obligations entail, the court has created considerable unease and uncertainty amongst doctors when attempting to exercise their discretion sensitively, as well as producing potentially problematic implications for legal consistency in end of life decision-making.