Do not resusitate order - family informed?

I am not saying a DNR is not appropriate but this has never been discussed with any of the family or my dad

Wot @Birdie6 said:

Resuscitation is a violent and damaging procedure with a very low success rate, op.

Can you honestly be absolutely sure that it has not been discussed with your father?

I am not sure whether you are aware but your allegation, if well founded, is an exceptionally serious, potentially career ending one for the doctors in charge

Is your father judged to have capacity to make decisions for himself? Have you been given access to read his medical notes ?

DNR by no means means that no further treatment will be provided. It is all about not leaving ill people with broken or damaged ribs on top of everything else, with very little chance of success as PP have already made clear.

Getting good information can be quite the challenge across a family, especially if you are not around for all the consultations. While your father is judged to have capacity, he is the person who will be consulted. Do you have POA in place ?

Going straight to accusing the medical staff of putting on a DNR order without consultation is not likely to help anything

You are going through a very difficult time as a family. Take care of yourself, take time to breathe and avoid jumping to conclusions can help to make a very difficult time at least not worse

DH requested a DNR after speaking to the medical team about what lay ahead for him. I was devastated at first and felt like he was giving up, but the last few days of his life were so traumatic for him that I could understand why the doctors had recommended it and although it took all my courage and love not to attempt CPR when he stopped breathing, I know he died peacefully in the end with dignity. for you, it really is difficult. My DH had COPD, lung cancer and brain mets, but what actually killed him was a double dose of pneumonia and sepsis because he was unable to cough the infection up, which led to hardened deposits narrowing his airways and suffocating him. In those circumstances, he would never have been able to recover, and resuscitation would only have prolonged his suffering.

Resuscitation is a violent and damaging procedure with a very low success rate, op. For someone in your father's condition it would be fruitless to even attempt it. Surely a relatively peaceful end is what we all want - and what you and your Dad would want. I'd ask your GP to talk to him, if he is questioning this DNR decision .

Sorry, that was a bit rambling, wasn't it? What I mean is, someone being DNR doesn't necessarily mean signing their death sentence there and then, any more than making a will means they're going to die at once. It's for the future, hopefully. That said in any care home situ I'd have it plastered on the walls for the visiting paramedics just what would be DNR and what isn't, for the avoidance of doubt.
Just in case they jump the gun.

I should point out that while I respect what billinisurge says, it might be inadvertently misleading, because it makes it sound like her parent opted to go to Dignitas or something, or made some unnecessary decision. As far as I'm aware, the DNR does not mean 'oh, you've had a heart attack, so now we're going to let you die' though it also depends on all kinds of other things, so if the person has significant dementia, and generally suffering all round, as was described on page one by someone on this thread, then legally and ludicrously, the State has a duty to save that life anyway, or be held legally responsible. Even if it means prolonging that life beyond its natural timespan, as science can do that.

Now, it turns out I'm now being misleading, because you'd think if that were the case, folk in care homes might be treated better but not a bit of it. From what I've experienced, it is clear to me that some Surrey care homes, for instance, are secretly tasked with killing the elderly off via dehydration. All they need is 'severe dementia' scribbled on the medical notes, and they can go ahead with it, it seems. a) The family need not be informed and b) Your parent need not have 'severe dementia'. Just so long as it's on the notes - which you can't see if you didn't get LPA in Health and Welfare when you could - then that makes it true.

So, just because there's this pernickety legal finessing in A&E regarding end of life, don't imagine for a moment that applies in care homes. It's the wild west out there, with no sheriff in town, and different rules apply.

I've spent a lot of time over the last few years persuading extended family about the merits of a DNACPR form.

People die. Especially when old & crumbly (like my grandparents). CPR in that situation is torture.

DNACPR does not mean stop Care. Although I do think we sometimes need to assess the impact of likely interventions eg. My grandfathers final illness was pneumonia. My aunt wanted him to go to hospital for IV antibiotics. The rest of us pushed for being quietly managed in his room at the Care home by the staff that knew him and us. It was much better than dying on a busy medical ward. I don't think IV antibiotics would have turned things around and even if they had he had told us repeatedly in lucid phases that he didn't want to be alive anymore.

Everyone needs to think and talk about these issues. Not enough families do.

Op Im in NI. My mum died in the Royal.

The day before she died the Drs spoke to me alone to get the family opinion on resuscitation. I was the one there at that point, the Dr asked me what myself and my sibling's thoughts were and I gave it straight. Mum was to be DNR. No question.

We also agreed to a post mortem as well, as there were several questions over what actually was wrong and she was too ill to test for some of them. We got our answers from the post mortem.

Everything was failing and she wasnt able to eat, drink (despite many hours of persuading), she was gasping for breath even with the oxygen mask on, her heart was in failure, her lungs were drowning in fluid, her kidneys had failed and other problems. Her lungs had already been drained many times and were getting hard to do repeatedly.

She had already made her peace that she was going to die and as a family (without her) we had made the decision that as there would be no chance of prolonging life and that resus was futile overall, so not for resuscitation and keep her comfortable and call us at any time.

There were 5 teams of Drs involved and they all agreed with us.

I was home that night at 2 am, my phone rang at 8.57, to come to the hospital, my brother got a few words from me on the phone and we both made our way to the hospital and we held her hands and talked to her until she passed. The last thing she saw/heard/ felt was us, and we talked right to her telling her we loved and her job was done, she was free to go meet my father (she literally faded at this).

I asked my brother to push the button for the nurse as it was on his side, I had kept my fingers on her pulse and felt it fade. The nurse checked her pulse for us and it was gone. her death was recorded shortly after. It was peaceful and loving and with the 2 she loved the most in the world supporting her.

CPR would have been invasive and prolonged and she would have been without us, alone being worked on for something which didn't stand a chance to help, would only prolong things in this case and would cause severe pain until the next attempt.

However, if we had thought for one moment that there was going to be a life afterwards we would have fought for her every step of the way.

It was a good death, with those who she loved supporting her and no intervention as it wasnt going to help just prolong.

Yes, with your dad's permission ask all the questions you need to and good luck. If you want to pm me or anything, you know where I am

I suspect the doctors talked to him in a less direct way, or asked him whether he would want certain interventions, it may be a while ago. He may have forgotten or doesn't want to upset you. Where there's no quality of life and no chance of improvement dnr is usually the kindest thing to do - some family members react badly as they are confusing it with euthanasia, it's not, it's just saying they wont take extraordinary measures like resuscitation.

I've gone through this recently in my family and they really didn't understand and it took a lot of conversations to make them realise its a precaution for the future rather than for right now.

Hope you come to peace over it

That should be had to not has to. She died two years ago.

My mum has to renew her DNR regularly- usually after every hospital stay. I remember queuing up at her GP's with her latest one to hand it in. It broke my heart but it was her decision- she was a nurse - and I didn't feel it appropriate to challenge her on it. She was fully informed about it and completely understood the arguments for and against. I felt it was my duty to respect that.

The DNR thing is a minefield because it make sense but can also be a loophole by which, yep, the cash-strapped hospital can finish someone off, no questions asked.
It should be made clear that it is very intrusive, to bring someone back to life when they have had enough is almost Frankenstein really, and on a technicality. It means massive shocks on the chest with those pads to get the heart going, a tube down the throat, all kinds of things.
That said, in March 2014 after my mother had gone into hospital after care home neglect, I was called out because her BP had gone down to 40/20 and they thought that was curtains for her.
She did not have DNR in place, so they needed me to sign something. So we had a big chat but I really wasn't ready to let Mum go. It meant we had a set-to with the young GP on duty, who was actually a decent bloke, and she did actually pull through.
We got another three and a half years out of her, albeit with diminishing returns, but that's Parkinson's for you.
Nobody from the Council's Social Services or anyone held accountable for the care home, which I later found out, had failed its CQC inspection on all counts the month before, with nobody being told - but that's adult social care for you.
My point is in this case, not having DNR meant they called me out and I could speak up for her, argue her case.

On the other hand, I heard of another person in a care home on respite for a week or so, she had DNR but the papers were not at the home. So, after a massive heart attack, they resussitated her in all its awfulness. She spent the next 24 hours or so in the local hospital, twitching like in shock, apparently, and the daughter was furious. In the end she had to get the chaplain to have a word, who really got on the case, and - though nobody is supposed to know the State can do this, we get sold all that 'Isn't Dignitas awful' misdirection, the doctors gave her a shot and she died.

So not having DNR can be a very painful situation... it doesn't mean they can't make things comfortable with it in place.

I feel for you, OP.
For people interested, the lady who wrote Call the Midwife (Jennifer Worth) also wrote a brilliant book on ageing and end of life care. I was really impressed with it. It's called " In the midst of life". It's a true documentation of her few years working in a hospital.

That’s a great list anna

No he doesn't have to sign anything to say he's been informed of the DNR.

Not familiar with NI but I would guess they have some form of process like the rest of the UK where a form is left in the property, usually in his district nursing notes or somewhere like that.

The doctor documents what was said to your Dad in his notes. If your Dad isn't remembering things, or just is burying his head in the sand, that may be where the issue lies. Or potentially it wasn't done well. But they don't have to ring round all the family members - the key person they talk to is your dad, not anyone else.

I’m pretty sure it’s the same in NI, although I’ve never actually worked there. It’s a medical decision. Whoever filled the form in should, as Anna said, have documented the discussion that was had with your dad, or if no discussion was had why one was not possible.

If your dad has no recollection of this (and quite often patients chose to blank this out) or genuinely hasn’t had a discussion with anyone your GP or any hospital doctor he sees can go through this again.

Oh, I am glad you have a phone appointment.

I'd suggest you make a list of questions you would like answered and things you really want to tell him eg:

He says he gets up and walks but actually the last time he really went out was x

He only eats y amount

He is having problems with his memory

Mum won't tell you but she needs help with ...

I would like to know what his diagnosis is

What does this mean

What is his prognosis - I would like you to be blunt with me

In the UK there is a common belief among patients that they have to sign a DNR - I also fill them out daily both in hospital and community and will regularly have patients ask me 'where do I sign?' but there is actually nowhere on the form for a patient signature, but a clear place for the documentation of discussion.

As collectingcpd says, it is a medical decision and often the first thing that goes through the doctor's head is 'will this patient be accepted by ITU' because every survivor of CPR will need to go there. If the answer is no, and ITU will only accept patients they think will benefit from treatment there, then your decision is essentially made for you.

Dying in a CPR process is really horrible as those of us old enough to have been in practice when very few people had DNRs can tell you. It much better to die quietly and peacefully with your family by your side and any drugs you need to make you comfortable, than your family kicked out of the room while a team of strangers go through a horrible and undignified ritual which has no hope of saving your life.

OP sorry if the latter part of my post seemed a little harsh. I am genuinely sorry that you are having such a tough time. I see your story on a daily basis and am just frustrated that the government has made no attempt to educate the public about dying- it’s oretty much the only certainty we all have in life, yet no-one wants to talk about it. Go and have a chat with your dads GP or consultant (with you dad’s consent).

I’m intrigued by this thread and am wondering were in the country you are based. I’ve been a doctor for 20 years and filled in DNARs on an almost daily basis. I have never had to get the patient to sign one, and the last hospital I worked at was paperless, so there would have been no-where the patient could have signed. I’ve never seen a community DNAR form (ie one done by a GP) signed by a patient either.

To complete a DNAR form doctors don’t need patient or relative consent. It’s a clinical decision. If an elderly patient in hospital is deteriorating, has lost capacity and I’m unable to contact relatives, that doesn’t mean I HAVE to do CPR on her, but I do have to explain on the form what attempts I’ve made to contact relatives and why CPR would be futile.

As a pp has explained a DNAR form simply means if a patient’s heart stops CPR should not be started. It has no other bearing on clinical treatment.

It doesn’t sound like your dad is a candidate for CPR. Anyone who survived CPR will require a stay in ITU in an induced and medically managed coma. Most patients come out of ITU in a physiologically worse state than when they went in. ITU can choose NOT to accept patients who they don’t think (based on their co-morbidity) will survive. Some-one who is elderly and already on home oxygen is a) unlikely to have a successful outcome from CPR in the first place and b) if CPR was successful ITU would refuse to accept them......so now medics are left with an adrenaline (patients are given this as part of CPR)dependent patient whom ITU have refused and whose heart will stop again once the adrenaline wears off.......so at that point do you want us to start COR again, and get ITU down again.....to say ‘no’ again?

If families are adamant that they want CPR, we medics will oblige, for at least one or two rounds.....then we stop, and the family is grateful because they think we did something. CPR is a completely hideous and barbaric thing to do to anyone who hasn’t got a hope of surviving it in the first place......but in the UK we seem to have totally lost sight of the fact that getting old and bits of our bodies failing is all part of the dying process.

You don't sign your own DNR. It's signed by your consultant or GP.

It's a medical decision - unless you personally want to be DNR in which case you can ask for one at any time including when you are really healthy.

From the details you have given about your Dad, sadly it sounds as if were his heart to stop beating, it is incredibly unlikely that CPR would restart it, so medically a DNR is appropriate.

In these situations a doctor should explain to a person why they are DNR - there is a process for challenging it by asking for a second opinion but it is likely that the second opinion would be the same as the first.

If your Dad doesn't remember things from 10 minutes ago, or tends to say he is fit and well and walking about, when actually he is in bed on oxygen, it could well be that he has been told about how unwell he is and the DNR but forgotten it or batted it off.

I'm really sorry this has all hit you so hard

I'd suggest it would be a good idea for you to fill his GP/consultant in on how he really is if he/your mum don't tell the truth when he goes to appointments. Can you go with him to his appointment on the 18th?

My father died of lung cancer last year. Me, dh, dm and our 3 year old were visiting him when the consultant did a ward round and she told us then that if anything happened they wouldn't be resuscitating him. It was as much news to him as it was to us and he died about 3 days later. His face just crumbled. I was six months pregnant at the time and he desperately wanted to hang to meet the new baby.