The ‘Do Not Resuscitate’ Movement in Prisons

I decided to write this post following recent media coverage of two deaths of prisoners in UK prisons during the past week. Both were natural deaths, in the sense that the cause of death in both cases was a long-standing serious illness, but the detail that caught my eye was that the two cons concerned had both signed ‘Do Not Resuscitate’ (DNR) instructions – one had even had it tattooed on his body.

Pity about the spelling

These two stories interest me because I myself signed just such an order – often referred to in medical circles as a “No Code” – while I was in prison. It is a legal form that (in theory, at least) is supposed go on a patient’s (or prisoner’s) file to prevent the administering of cardiopulmonary resuscitation (CPR) – including chest compressions or the ‘kiss of life’ or advanced cardiac life support (ACLS) if that person’s heart stops or they have ceased breathing. In essence, a DNR means that if you stop breathing, you don’t want to be brought back. You want to stay ‘brown bread’ (dead).

You might be surprised just how common this sentiment is in prisons, even among those cons who aren’t feeling suicidal. I know a fair number of lifers, or inmates serving Indeterminate Sentences for Public Protection (IPPs), as well as elderly prisoners, who have signed up for DNR in order to make their wishes clear. 

As I’ve written in the blog previously, I’m not the suicidal type myself, but I have seen some real horror stories inside prison when it comes to healthcare – or the lack of it – in the nick. After one terminally-ill prisoner who really wanted to die was repeatedly resuscitated by wing screws (who no doubt meant well), I decided that in the unlikely event that my slightly high blood-pressure did stop my ticker beating, I most certainly didn’t want to suffer the same fate.

IRC Morton Hall

My reasoning was as follows: if I was so unwell that I experienced sudden cardiac death while in prison, there would almost certainly be an extended delay in any type of help arriving. If you doubt this, just look at the media coverage of the recent death in detention of Rubel Ahmed, a 26-year old immigration detainee at Morton Hall Immigration Detention Centre in Lincolnshire. 

Although the alleged circumstances of Mr Ahmed’s death are being disputed by the Home Office – which has informed his family that he committed suicide – other detainees have spoken of him suffering from chest pains the evening before his death and claim that he desperately tried to attract staff attention to get help by banging on the locked door of his room, but was ignored until it was too late to save his life. Let’s hope that the truth behind this tragic incident will eventually come to light during the investigation and inquest. 

However, this sort of incident is one of the main reasons that I – and other prisoners – signed up for DNR. Perhaps the one thing worse than being dead is surviving in some horrendous persistent vegetative state on life support owing to irreversible brain damage because of long delays before CPR is attempted. Being in prison was bad enough, but that would be far more of a trauma for my family, so I spoke to the duty nurse in Healthcare and asked if I could sign up.

Typical DNR form

The reaction was somewhat unexpected. I was immediately quizzed as to whether I felt suicidal? No, I explained, but I do have a history in my family of sudden cardiac death, as well as higher blood pressure than normal for a man of my age. The nurse reacted with about as much hostility as if I’d put in a request for a length of rope or some cyanide with which to top myself!

Next, she made an urgent appointment for me to see the duty doctor. This was actually the first time I’d seen one in the slammer. He was extremely pleasant and we had a very relaxed chat about my concerns. 

Although he did express the view that CPR in such cases can have a positive outcome, he also agreed that extended delays in the administration, such as can occur in prison setting, might not be a great clinical decision in some cases. Having satisfied himself that I wasn’t about to use the TV coaxial cable to string myself up anytime soon, he agreed to put the required note on my medical file and to ensure that both wing staff and the healthcare team were aware of my wishes. He did, however, book me in for a routine electrocardiogram (ECG), just to check my heart. And he tested my blood pressure, which wasn’t too bad.

Getting the message over

Of course, in reality I also accepted that even having signed up for DNR, there was no means of guaranteeing that the night screws – who often find that they have to deal with this type of emergency – would even be aware of the notes on my prison file. When the alarm is sounded at 3 am, checking the computer doesn’t come very high on the list of priorities.

There is another irony about my own decision to sign up for DNR. In my first nick I trained as a gym orderly. When I was sent down I was actually in pretty good shape and used to visit the gym four times a week after work, as well as run regularly, so I was quite keen to stay fit and keep my weight down. Working in the gym was an attractive option.

A qualification many cons gain

Part of the gym orderlies’ course was called Heartstart, sponsored by the British Heart Foundation, and I am trained in Emergency Life Support (ELS) skills, including CPR. Quite a few cons take these courses, so there are probably more qualified first-aiders on prison landings than there are outside in the community. 

On occasion, cons who have given up the will to live, will attempt suicide and I’ve known individuals personally who have written ‘DNR’ on their chests, carved it into their flesh with razor blades or even tattooed it prominently on their bodies (a breach of the prison rules on tattoos, by the way). In these cases, there’s also no guarantee that anyone will take any notice of their wishes, but I suppose it is a pretty forceful statement of intent. For a person who doesn’t have anything much to live for, death – in either its natural or premature forms – can seem to offer a way out and, sadly, for some prisoners it can seem to be the best chance they have for release.