New guidance on DNR orders brought forward Janet Tracey died at Addenbrooke's hospital in Cambridge in 2011. Guidance to doctors and nurses on decisions about whether or not to resuscitate patients is being reviewed amid concerns over whether it is being properly implemented. Criticisms from the health service ombudsman and inspectors on the Care Quality Commission over the issuing of notices not to attempt resuscitation - known as DNRs or DNARs - combined with increasing publicity surrounding legal cases have led professional bodies to look again at their guidance (pdf), last published in November 2007. The British Medical Association (BMA), one of the bodies involved, said decisions on whether to resuscitate patients was "a complex area of medicine that can be very distressing for patients and people emotionally close to them." It said: "The BMA is currently undertaking a review of its guidance and, as part of this process, we will be considering any issues arising from individual cases." The most high-profile legal case on the issue, started in 2011, involves the family of Janet Tracey and Addenbrooke's hospital, Cambridge, where she died. The family want a national government policy for England requiring hospitals to consult patients and relatives before making DNR orders, following a dispute over the way two were issued on Tracey. Last year a high court judge said a judicial review of the legal issues would be neither appropriate or proportionate. The family, who have also alleged that the hospital denied Tracey's right to life, is appealing against this ruling but there is no date yet for a hearing. The Department of Health has argued that the NHS should have local policies on DNR issues, based on the professional guidance from the BMA, Royal College of Nursing and Resuscitation Council. The organisations originally planned to wait for a decision on the Tracey case but have decided they can delay no longer and now hope to publish updated guidance by the end of the year or soon after. The General Medical Council, which regulates doctors, has insisted doctors' decisions on treatment is final. Families of mentally competent patients have no legal rights on the issue, but doctors' leaders have previously made clear that it is good practice, where possible and with patients' consent, to talk to them too. David Pitcher, a cardiologist and chairman of the Resuscitation Council, said media attention on the Tracey case and others had been a factor, as had the five-year gap since the last guidance. "We felt it was time to review it, ensure it was robust and make sure it was up to date," he said. This would include ensuring decisions are known by other health professionals - backed up by documented proof - when patients either cross geographic boundaries or are moved, for instance, between hospitals, care homes or in or out of their own homes. Such transfers should also be a good time for such decisions to be reviewed, said Pitcher. Merry Varney, of Leigh Day, the company representing the Tracey family, said she was encouraged by the news. We however remain of the view that clear national guidance and information is needed not just for medics but for patients and their families which makes clear when these orders should be used and the manner in which they can be implemented. In Scotland there is a national policy on resuscitation decisions, and in Wales moves are afoot to improve cross-boundary decision-making and communication.