DOLs

Hi Liz and Jo,

I try to avoid DoLS as I have enough trouble arguing with 'the NHS/professionals' about simpler end-of-life issues - however, I do 'read a bit of DoLS stuff' and I'm not sure that this question is all that clear in legal terms. And EoL behaviour is essentially 'legal first, and only afterwards 'moral'' [if 'moral' comes into it at all - mixing morality and law, can get very 'confusing'].

It would help me, if I had any idea what 'a statement of intent ' is ? Not a term I'm familiar with (although, it looks to be connected with Advance Care Planning, and ACP is in my view 'often something of a mess, legally' as well).

So I'm unsure exactly what this is telling me:

'My moral issue is that if you have a dols you can not have a statement of intent .'

This entire question looks as if it is a comment about the complexity of 'MCA best interests decision-making' if people who are not 'embedded in the patient's care long-term' become involved (for example, the 999 Services or OOH) - it would help, if those [essentially inadequately informed] people accepted that they cannot make 'best interests decisions' as a start (something I repeatedly point out !).

As for:

' Explaining to a family member that police will attend when their loved one passes causes emotional distress this distress is passed on to the loved one'

this looks rather like my 'current community EoL CPR/VoD policies are flawed and inadequate, because they do not properly handle deaths which 'are not 'formally expected'' but which a GP might certify if the GP attends post-mortem' issue - I touched on that in my BMJ piece at:

http://www.bmj.com/content/347/bmj.f4085/rr/654490

If Jo wants to e-mail me (see the BMJ piece above), I would be very happy to see if I can shed any light (no promises),

Mike

Jo has sent me a brief e-mail explaining what a 'statement of intent' is:
'Statement of intent is put in place by g.p when they expect someone to pass within two weeks it is renewed if needs be . Since dols have been introduced you can't have statement of intent if dols in place.'

I would quite like to 'have a word' with whomever came up with this particular piece of nonsense - it isn't even one of the more difficult end-of-life issues.

THE LAW AND LOGIC TO THIS

The rules for certification of a death by a doctor (which will be the GP for a community death) are [in England - different rules in Scotland]:

1) The GP can certify the death WITHOUT SEEING THE DECEASED PATIENT'S BODY POST-MORTEM provided the GP has seen the patient within the previous 14 days;

2) Provided the GP visits the scene of death and sees the body post-mortem, the GP can decide to certify the death [even if the GP had not seen the patient within the previous 14 days].

The concept of 'community expected death' is that some deaths are so expected, that the police should be kept away, because 'it is understood that the GP will certify the death'. As I put it in a BMJ piece:

http://www.bmj.com/content/347/bmj.f4085/rr/654490

Laurie R Davis (this series of rapid responses, 11 July 2013) has commented 'It can have workload implications as there appears to be a widespread belief amongst care homes that patients who might die should be visited by their GP every two weeks.'
The reason is probably the grossly inappropriate and hugely insensitive behaviour of police for EoL community deaths, when the death is not 'expected'. In this context, expected has an obvious logical meaning: an 'expected death' is one which occurs after the GP has 'promised to certify even if I cannot attend post mortem' (with the safety provided by that promise, the coroner can hugely relax the investigative aspect of post mortem behaviour, effectively instructing suitably trained nurses/etc that 'unless the death was obviously unnatural, just arrange for the body to be removed, try to keep the police out of it, and do not pester grieving relatives').
There is no guidance within current community policies, which properly addresses 'I would not be surprised if the patient dies, but I would need to attend post mortem before deciding whether to certify' - currently police behaviour tends to treat 'early EoL death' as very much akin to the sudden death of a believed-to-be-healthy 25 yr old. This is absurd, to put it mildly, when you are in the position of a person who is living with the patient. The transition from considerate treatment by nurses and the GP, to 'being treated by the police like a suspect when my loved one finally died', is a huge shock to the just bereaved, and very 'disturbing'. I also think such police behaviour reinforces long-term memories of the death itself, which is a bad thing, and is being ignored by policy
creators.
So the death of an elderly patient who 'might die any time, but I (GP) cannot say whether tomorrow or in a year's time' is treated as a 'sudden death' unless the GP attends post mortem and decides to certify: and even an 'expected death' will become, from the perspective of the care home, 'a death we, and the police, are not certain will be certified' if the GP has not visited within the previous 14 days. The police have a strong tendency to 'seek to investigate in depth' any death until certification is effectively a certainty - this damages bereaved relatives, and is neither 'balanced' nor rational, if a patient is known to be 'very elderly, final-year-of-life or has a condition which involves an ongoing but small probability of 'dying at any time''.
And the care home, or a relative in the patient's own home, cannot be certain that the GP will be able to attend promptly, when the death occurs.

BMJ piece ENDS

Can doctors predict when a patient will die with sufficient certainty ? The answer is 'no' !

For example, there is a House of Commons select committee report which you can download from:

http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/805/805.pdf

Section 37 includes this description of 'how people die':

The British Medical Journal has described three distinct illness trajectories for people with progressive chronic illnesses:

• a trajectory with steady progression and usually a clear terminal phase; mostly cancer

• a trajectory with gradual decline, punctuated by episodes of acute deterioration and some recovery, with more sudden, seemingly unexpected death; for example, respiratory and heart failure

• and a trajectory with prolonged gradual decline; typical of frail elderly people or people with dementia.

I included in my piece posted at 17/01/15 - 13:59 at:

http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj=viewThread&threadID=759&forumID=45

this:

Also, it isn't possible to argue that 'sudden arrests' do not happen:

The BMA publication 'A-Z Family Medical Encyclopedia', fifth edition published in 2008, ISBN 978 1 4053 2987 3, includes under 'Death, sudden':

'Unexpected death in a person who previously seemed to be healthy ... Cardiomyopathy (disease of the heart muscle) may cause sudden death at any age, and its presence may have been unsuspected.'

It isn't even possible to argue that 'unexpected death' makes any sense at all, for known end-of-life.

Imagine that a patient is elderly and 'very frail', and the GP 'would not be surprised if he/she died'. Assume that the probability of dying on each day remains fixed - and assume that 'an expected death' is when the GP expects the patient to die within 14 days. It turns out, that 'death within 14 days' is approximately the same as a 1-in-10 chance of dying today, followed by [if you don't die today] a 1-in-10 chance of dying tomorrow, etc.

So, if 'expected to be dead within 2 weeks' is the 'requirement' for 'formal expected death', a 1-in-10 chance of dying each day is the lower limit - but how is 1-in-10 so very different from 1-in-11, which would be 'an unexpected death' ? IT ISN'T - the idea of 'unexpected death' is FLAWED AS A CONCEPT for the very elderly, and the the 'very frail'. And to boot, no doctor could be confident that 'this patient has a 1-in-10 chance of dying today - if that was 'the best prediction' no doctor would be genuinely surprised if the chance was really 1-in-6 or 1-in 15.

The idea that it is possible EVEN IN PRINCIPLE to categorise some deaths as 'expected' [and to keep the police away from those] without excluding from that 'expected' category a large number of perfectly natural deaths, is flawed - we need to accept this complexity, and make sure that police behaviour after the 'unexpected' death of a 'frail but not expected to die within weeks' 80 yr old, is not similar to the police behaviour after the 'sudden deth of a thought-to-be-healthy 25 yr old'. It isn't that the police should be kept away from all EoL deaths - it is that for EoL deaths, there should be some actual evidence of 'foul play' before the police 'imply there has been foul play here [by the 'attitude and behaviour' which the police exhibit]'.

BUT THE 'RULE' JO POINTED AT IS ABSURD !

Setting aside this absurd sharp demarcation between 'expected' and 'unexpected' EoL deaths, the idea that the presence of DoLS (which is either a mental capacity or mental health issue) IS RELATED TO THE PROBABILITY OF A PERSON DYING [a natural death] is logically flawed - they are simply not 'dependent'.

The problem at the moment, is the '1-in-11' to '1-in-50' or even '1-in-100' chance of dying on any given day situation - it isn't that the police should automatically be kept away from this type of death: but the police should NOT BE ALLOWED TO EQUATE THAT LEVEL OF PROBABILITY WITH 'AUTOMATICALLY SUSPICIOUS'.

It is reasonable for the police to ask people - ONCE - 'what happened': it is reasonable to retain the body until the coroner has 'reached a decision': but it ISN'T REASONABLE to 'treat everyone like suspects' IF THERE IS NO OBVIOUS INDICATION OF AN UNNATURAL DEATH.

A closing comment (although I feel sure, that I will be returning to this thread). A lot of people DO REALISE THAT THIS PROBLEM EXISTS - for example, a GP copied me in on an e-mail to the local Ambulance Service last year (but note that 'expected' isn't, in fact, 'a legal term' - it is an operational device - also note, as this is not pointed out by the GP in that e-mail, that I phoned the GP's Surgery, the GP had taken the day off, and the GP's receptionist TOLD ME to call 999 [which is why I ended up talking to a paramedic]):

EMAIL STARTS

'Dear XXX,
Thank you for meeting me to start preliminary discussions about our planned film to support the community teams with managing LYOL conversations and deaths at home.
Reading the commentary below, which I received from Michael Stone about his personal experience,
-When my mum died at 8-15am, after 4 days in a peaceful terminal coma, and I waited until 9am to call the GP the first thing the paramedic said was 'The death was sudden, because I was called'. This was despite my telling him, that the GP had told me to describe the death as expected to any cover GP: the lead DN turning up about 15 minutes later, should have sorted this out, but failed to. The paramedic asked the DN 'Was it an expected death' and I'm fairly sure the DN said 'Yes but not necessarily today'-
As you know we have had a recent death of a 103 yr old woman in a nursing home where the ambulance and police were called.
I wanted to ensure that our DN teams are aware of the importance of clarifying to ambulance staff that a death is EXPECTED. This is a legal term that ensures that the family are treated with compassion by ambulance staff and the police, in the unfortunate event that they are called.'

EMAIL ENDS

So the problem, is one of inappropriate balance - currently the police objective of 'discovering murder and assisted suicide' is NOT CORRECTLY (neutrally from an 'all perspective' view) BALANCED against 'the [psychological] damage caused to bereaved relatives, when the police treat just-bereaved relatives as if they are suspects'.

I've just noticed that my proof-reading wasn't at all good in the previous piece - but I think it still makes enough sense to follow.

The Marie Curie forum, which I've just discovered, allows you to edit your posts, which I like: but MC doesn't allow you to post under your real name (even if you want to), nor can you 'investigate issues' on its site (which I don't like !).

There are many moral issues around end-of-life, and there are also legal issues, and a serious complication with 'muddled terminology'. I might post a piece describing some of those in the near future.

But the one Jo has raised, is just 'an obvious logical mistake' (and very annoying, to boot).

'Statement of intent is put in place by g.p when they expect someone to pass within two weeks it is renewed if needs be . Since dols have been introduced you can't have statement of intent if dols in place.'

Imagine that two elderly twin brothers, Tony and Eric, are both living in the same Nursing Home. Tony is still 'mentally as sharp as a tack', but Eric 'gets confused': in particular, Eric has totally 'lost road sense', and tends to walk off the pavement onto busy roads. The nursing home is close to a busy road, and there is a DoLS for Eric, because of this situation.

Tony and Eric are both relatively frail, they have the same GP, and both of them have got (a similar) heart condition - this serious heart condition could result in either of them 'going to sleep one night, and never waking up again', and the GP 'expects both to die within weeks'.

The idea that what Jo describes as 'a statement of intent' can be written by the GP for Tony, but not for Eric, is 'logically absurd'. If either is found dead in bed, or dead in a chair, inside the home, Eric's DoLS is a total irrelevance: it would be different if Eric was found dead, knocked over on a local road (when the police should be involved, and the DoLS becomes a relevant issue).

To be frank - and at risk of upsetting a few people - this is type type of 'obvious stupidity' which I keep coming across when I read 'NHS/coroner/police stuff about death', and overall it does make me wonder about the 'experts' who are writing some of the guidance/policies !

I sent a question about this, as an add-on to something else I was asking, to my DH 'contact' yesterday. It turns out that she is on leave until 5 May, but if I get a reply which sheds any light, I'll post it here. Doubtless there will be dozens of e-mails in her Inbox on May 5th, so a reply is by no means certain.

However, the other question is one I will be repeating if I don't here back by ca. May 12th, so I might get something (it is complicated by the fact that I asked my contact, for the DH address of someone else - and I also guessed at that other address: so I might get an answer next week, from this other person, but to the other part of my question).

I'm not being very clear - the point is, I'm trying to get the DH to explain this 'you can't have both DoLS and expected death' thing, and if they explain where it comes from, I'll post the info !

The Department of Health is now aware of this issue.

I sent an e-mail to someone at the DH on Saturday, and a reply e-mail I received yesterday afternoon includes:

'I have forwarded your email on to the DH DoLs team for them to respond to your [separate] enquiry about DoLs.'

I'll update if the DH DoLS team tells me anything, and what I sent to the DH re this issue is shown below,

Mike

PS Can the DH help me to understand 'where something comes from' ?

It seems that at least some people, 'believe that you cannot have 'expected death' at the same time as a DoLS'. Not only logically unsound and over-simplified, but that could increasingly cause trouble as morr people die with dementia - I stumbled on this at:

http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj=viewThread&threadID=783&forumID=45

As I wrote in one of my comments there:

'Statement of intent is put in place by g.p when they expect someone to pass within two weeks it is renewed if needs be . Since dols have been introduced you can't have statement of intent if dols in place.'

Imagine that two elderly twin brothers, Tony and Eric, are both living in the same Nursing Home. Tony is still 'mentally as sharp as a tack', but Eric 'gets confused': in particular, Eric has totally 'lost road sense', and tends to walk off the pavement onto busy roads. The nursing home is close to a busy road, and there is a DoLS for Eric, because of this situation.

Tony and Eric are both relatively frail, they have the same GP, and both of them have got (a similar) heart condition - this serious heart condition could result in either of them 'going to sleep one night, and never waking up again', and the GP 'expects both to die within weeks'.

The idea that what Jo describes as 'a statement of intent' can be written by the GP for Tony, but not for Eric, is 'logically absurd'. If either is found dead in bed, or dead in a chair, inside the home, Eric's DoLS is a total irrelevance: it would be different if Eric was found dead, knocked over on a local road (when the police should be involved, and the DoLS becomes a relevant issue).

To be frank - and at risk of upsetting a few people - this is type type of 'obvious stupidity' which I keep coming across when I read 'NHS/coroner/police stuff about death', and overall it does make me wonder about the 'experts' who are writing some of the guidance/policies !

Hello,

Not sure if we are talking about the same thing here as I am struggling to fully understand the question, but is there perhaps some confusion about the requirement for a Coroner for anyone subject to a DoLs,
"on the law as it now stands, the death of a person subject to a DoL should be the subject of a coroner investigation because that person was in state detention within the meaning of the Coroners and Justice Act 2009."
This has been legislated for some time, it is not a policy decision, sorry unsure if I understand the rest of the question, I'm very familiar with the DoLs code of practice, and wonder whether this question arises from some misinterpretation?

Hi Michelle,

What does 'a coroner investigation' imply, is the issue ?

Does it mean the police have to attend the death and behave as if something 'suspicious' has happened - or does it simply mean that the death has to be REPORTED to the coroner ?

I will clearly need to track down these regulations re coroners and DoLS - but there is an enormous difference between someone detained under the MHA because of a mental illness which might lead to a suicide attempt, and an elderly 'sometimes confused' care home resident who is being prevented from 'wandering off' and who has got an MCA DoLS in order to keep the person safe.

In any event, even if a death does have to be reported to the coroner, that has no bearing on whether a GP treating the person can 'believe he will die within a couple of weeks' - GPs should be able to record that, which is an 'expert medical opinion and hence outside of the coroner's role' whether or not there is a rule requiring the death to also be reported to the coroner.

Unless GPs can clearly explain in the notes, that their medical opinion is that elderly patients with both dementia and a DoLS 'are likely to die within days', there will be increasingly chaotic and inappropriate behaviour with an increasingly elderly population elderly and more prevalent dementia (and I've got a suspicion, that people in their own homes are much less likely to have a DoLS than those in care homes, in identical medical situations - if my suspicion is correct, that makes it all even more 'messy').

I've just started using the final 15 minutes of today's online time to look into this further - so far these look relevant:

https://www.judiciary.gov.uk/wp-content/uploads/2013/10/guidance-no16-dols.pdf

http://www.bjhealthlawyers.com/resource/deprivation-liberty-safeguards-coroners/

I have so far only had time to 'merely glance at parts of the PDF' (literally 'seconds') - I suspect, it isn't going to answer the question I just put to Michelle, and instead it asks the same question:

6. But for now the purpose of this guidance is to give coroners a steer on the application of DoLS in the context of coroner work. It will of course be a matter for coroners in the exercise of their independent judgment, and subject to any subsequent ruling of the High Court, to decide each case for themselves.

Hi,

Still a little confused over this 'statement of intent' which is perhaps something completely independet to DoLs, and is of course completely different to the MHA, in short the obligations of coroners is not a new issue:
'State detention' is defined in section 48(2). 'A person is in state detention if he
or she is compulsorily detained by a public authority within the meaning of section
6 of the Human Rights Act 1998.' Section 6 is headed 'Acts of public authorities'.
37. If a duty to investigate arises under section 1, the investigation may not be
discontinued if the coroner has reason to suspect that the deceased 'died while in
custody or otherwise in state detention': section 4(2)(b). In those
circumstances the coroner must therefore hold an inquest: section 6.

regarding "GP treating the person can 'believe he will die within a couple of weeks' - GPs should be able to record that, which is an 'expert medical opinion and hence outside of the coroner's role' whether or not there is a rule requiring the death to also be reported to the coroner" I'm struggling to see the congruence with the law here, the requirement for Coroners is simply because tthe deprivation has been made but 'the state' in the same way as MHA detentions.

People in their own homes are less likely to be Deprived of Liberty because in most cases their care needs are less likley to meet the 'acid test' of deprivation.

Hi again Michelle,

I actually hunted down and glanced over some DoL(S) stuff last night and this morning - I'll post my conclusions this afternoon.

It looks 'very messy' !

I'll try to extract from what I'm sending to the DH about this issue, and I hope I'll make this understandable !

It turns out, that this problem with the combination of DoL and what would otherwise be 'an expected death', is conceptually the same one as for 'earlier than 'formally expected' end-of-life deaths'.

The problem, is NOT whether the police should ATTEND those deaths - the problem, is how do you make the police behaviour (in terms of 'how deeply and forcibly they investigate the death') proportional to the likelihood that some crime has occurred ?

So the issue is the prevention of 'inappropriate police harassment' of just-bereaved live-with relatives for the 'somewhat early but known last years of life home deaths', and the prevention of such 'police harassment' of the care home staff for the 'DoL complication'.

I'll now insert the 'scenario' I sent to the DH - this should be clear.

Imagine two twin brothers, aged 81 and living in the same care home. Eric is still 'mentally as sharp as a tack' while his brother Tony is 'confused'. Tony has 'lost all road sense' and tends to just walk off the pavement into oncoming traffic. The care home is close to a busy road, and there is a DoL to keep Tony from wandering out of the home and onto a busy road.

Both brothers have got serious heart problems, and they share a GP: the GP expects that they will both die within a few weeks because of their heart conditions. It seems that Eric can be 'expected death' but Tony cannot.

So on a Monday, Eric is found dead in bed one morning, and his younger sister calls at the home to find everything after her brother's death 'calm and routine'. On the Thursday, Tony dies in bed during the night, and when his sister turns up she finds the police in attendance, and things do NOT seem to be 'calm and routine' - isn't the sister likely to reason 'that if the police are here this time, but they were not here
when Eric died, the care home staff must have done something wrong' ?

My solution to the 'early EoL death' problem was that GPs should record in the patient's medical notes two statements as they become medically correct:

'I (the GP) would no longer be surprised by the natural death of this patient, but I would need to attend post-mortem before deciding whether to certify the death'

followed at a later stage of clinical deterioration by;

'I (the GP) will now certify any death which is not apparently unnatural, even if I am unable to attend post-mortem'.

The second of those, is effectively Jo's 'Statement of Intent' - if the coroner knows that the GP will certify the death before the death occurs, the coroner and the local NHS can arrange to keep the police away from these 'expected deaths'. Even if the GP cannot attend post-mortem - staff who could not certify the death (for example a nurse) can verify the death, and arrange for the post-mortem formalities, without either the GP or the police being involved.

The DoL issue, means the GP cannot 'promise in advance to certify the death' in the same way.

But the GP could instead write this in the notes:

'I (the GP) would now certify any death which is not apparently unnatural, even if I were unable to attend post-mortem, except that the presence of a DoL prevents me from certifying the death and the law requires coronial investigation for any death with a DoL in place'

Now, the point of these notes written by the GP, is to offer better protection for the people who the police 'overly-question' - so the other necessity, is that the notes written by the GP, MUST be available to the live-with relatives if the patient is at home, and to the care home staff if the patient is in a care home. You MUST be able to point the police, if they are behaving inappropriately 'aggressively' towards you, at the relevant note and say to them 'Why are you so suspicious - the GP would not have been surprised by this patient dying, why are you apparently surprised ?' or 'Well, the GP knew he was about to die !' (depending on which note).

MOVING ON

I've always been interested in EoL at home, and how family/friends, who are in my view 'the closest support team', fit in. I'm interested, in how a family carer, is LEGALLY empowered to 'protect a demented person from danger': so imagine a variation on the Eric and Tony situation (see earlier) where the brothers are somewhat more physically healthy, and are sharing a [private] home together. When Eric and Tony go out shopping, or socialising, what is the legal authority for Eric to 'physically restrain Tony from wandering into traffic' ?

The copy of the MCA which I originally downloaded, tells me that:

4A Restriction on deprivation of liberty
(1) This Act does not authorise any person ("D") to deprive any other person ("P") of his liberty.
(2) But that is subject to-
(a) the following provisions of this section, and
(b) section 4B.
(3) D may deprive P of his liberty if, by doing so, D is giving effect to a relevant decision of the court.
(4) A relevant decision of the court is a decision made by an order under section 16(2)(a) in relation to a matter concerning P's personal welfare.
(5) D may deprive P of his liberty if the deprivation is authorised by Schedule A1 (hospital and care home residents: deprivation of liberty).

Tony is living in a private dwelling, so 4A(5) doesn't apply.

It is highly unlikely that for every situation when an 'elderly and confused' person is being cared for at home, a court order will be applied for ('ruddy impossible' ! springs to mind ).

Section 4(B) is apparently:

4B Deprivation of liberty necessary for life-sustaining treatment etc
(1) If the following conditions are met, D is authorised to deprive P of his liberty while a decision as respects any relevant issue is sought from the court.
(2) The first condition is that there is a question about whether D is authorised to deprive P of his liberty under section 4A.
(3) The second condition is that the deprivation of liberty-
(a) is wholly or partly for the purpose of-
(i) giving P life-sustaining treatment, or
(ii) doing any vital act, or
(b) consists wholly or partly of-
(i) giving P life-sustaining treatment, or
(ii) doing any vital act.
(4) The third condition is that the deprivation of liberty is necessary in order to-
(a) give the life-sustaining treatment, or
(b) do the vital act.
(5) A vital act is any act which the person doing it reasonably believes to be necessary to prevent a serious deterioration in P's condition.

Now, 'pulling Tony away from the road' is deprivation of liberty as I understand some recent legal interpretations of 'liberty' (which seem to interpret liberty as 'wider than freedom of movement') but without an application for a court order, 4B(1) doesn't apply - so that seems to rule out legal authority [for Eric's actions] arising from 4B.

And as I've already commented, nothing in 4A seems to give Eric the legal authority to protect Tony by 'removing his liberty to walk into the road', while 4A(1) actually states that Eric CANNOT remove that liberty from his brother. So although Eric's restraint of Tony is 'a vital act to sustain Tony's life' it doesn't seem to be a legally-authorised action - have I missed something ?

Now that I've come across this, I am bothered by it - and I'm also bothered that unpicking this, is much trickier than getting some far simpler bits of the MCA right (and the BMA/RCN/RC(UK) has got even those simpler bits wrong).

I did glance at Schedule A1 yesterday evening - I note (sections 19(1) and 20(1)) that DoL is not intended to over-ride the MCA's fundamental principle of 'patient self-determination', so finding the sections covering that principle wasn't difficult.

As an aside, the whole situation for 'end-of-life death at home' is currently a complete 'dog's breakfast' - I did a survey [to prove the point] last year:

http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj=viewThread&threadID=767&forumID=45

I am currently reading the DoLS Consultation paper (the DIC homepage has got the link to the consultation - and the paper is very detailed, and very long) and people seem to realise that DoLS is problematic in some ways for end-of-life situations:

2.30 Similar concerns arise in settings where care is not planned in advance, and where a deprivation of liberty may last for a matter of hours rather than days, such as in accident and emergency departments. There are other settings or circumstances for which the DoLS seem ill-suited. For instance, applying the DoLS procedures to hospices and end of life care may have no tangible benefit for the person, and the added formalities at such a sensitive time can cause
additional distress to families. Moreover, the person's stay in a hospice may well be for less than seven days, making a standard authorisation irrelevant.

It seems the Chief Coroner is also vexed by this.

There is a piece at:

http://www.communitycare.co.uk/2016/09/12/thousands-unnecessary-dols-inquests-causing-families-distress/

We are told in it that the chief coroner in England and Wales, his honour judge Peter Thornton QC, in his 2015-16 annual report, also warned the duty was causing "unnecessary" work for coroners and piling extra costs on councils.

'Coroners have been required to hold an inquest for anyone who dies while subject to the DoLS as they are considered as having died in "state detention" under the Coroners and Justice Act 2009.

Thornton said coroners had responded to the requirement with "sensitivity and compassion" but warned the situation was angering families.

"Why they ask, should their elderly relative, who suffered from dementia and has died a natural death, suffer the indignity of the coroner process? There has been unnecessary work for coroners and additional cost for local authorities."

The chief coroner has proposed that such cases should be removed from the category of "in state detention" under the 2009 act.'