Do Not Resuscitate order - urgent help needed

I’m a nurse. You really don’t want a frail, elderly person going through CPR and the subsequent recovery in the unlikely event it’s successful. CPR is brutal, I have an elderly resident in hospital at the moment and that’s the last thing I’d want for them - the extra time with them if they were brought back would likely not be long at their age and the injuries from CPR would mean pain. A slow recovery due to being frail and quite probably further time in hospital when they ended up with a chest infection as a result of the pain from broken ribs and immobility stopping them from deep breathing/coughing effectively to clear the chest.

A DNR is specific to resuscitation and has no bearing on what other treatments would be provided. The relative in question is awaiting surgery for a health problem once they’re well enough.

This is the reason why everyone should get LPA in Health and Welfare for their parent before it's too late. Without it, it's not really your decision anyway - the State decides, and the State profits from your parent's death. They do have to run it past Next of Kin, though - but they have no legal rights really.
I agree that the whole resuscitation thing is brutal and doesn't necessarily mean without it they just let them go. Everything else can be tried up until that point, and should be. You can make that clear - that includes being on a drip, being on a feed, plus antibiotics to cure the urine tract infection.
My Mum was in a similar boat after care home neglect in March 2014. I got called out because she wasn't DNR and her blood pressure had dropped to 40 over 20 and it seemed she wouldn't last the night.
I agreed to DNR after it was explained but made it clear she wasn't a goner.
She pulled through and lasted another three and a half years but we were lucky. It appears after the hospital put her on free NHS Continuing Healthcare they put her on a variation of the Liverpool Care Pathway and tried to have her killed via covert dehydration via various Surrey care homes, but that's another story - a story that leads me to believe that the ushering in of Covid-19 into care homes as no accident.

OP I am so so sorry. I see it's a few days later so for you this may now be irrelevant, but in case other people are in a similar situation....
My Mum had a lot wrong with her and died last year. In the end her kidney function deteriorated and that what took her. Her blood electrolytes (potassium levels etc) went out of normal range because of the kidneys. That caused her heart rhythm to be very irregular (you could see this as she was on a monitor) and a day or two later her heart stopped. Considering all the other ways she could have gone, which would have involved much more discomfort, I was relatively relieved.

@Mrsmorton and co:

You believe that not having blind faith in medics is offensive? There is plenty of evidence out there to disprove that theory, should any of you choose to look.

Nothing has come of your reports by the way, most likely due to them being silly.

Furthermore, your comments are offensive to those of us who have lost loved ones due to medical negligence and abuse.

Have a good one all

Am so sorry. Obviously the dehydration and anaemia can be treated in hospital, so hopefully this will make a difference.

Were you able to speak to a doctor?

The other aspect is that a 74 year old, looking after themselves, driving etc & seeming ok, is very different from a 54 year old. As we age, our resilience and ability to bounce back from illness, reduces, but this isn't something you can see or measure when someone seems well. Multiple conditions needing medications which then have potential to interact, don't help of course.

It's not uncommon in 70s and 80s for an illness which would have been shrugged off at 55, to prove unrecoverable from. This is bewildering for relatives, of course, and can seem 'ageist' when heroic treatments are advised against - it's not directly due to age, but due to the impact of age on ability to recover from illness.

I hope your mum's decline stops, and she can be built back up to her previous self.

My mum had an ITU admission last year with a DNA CPR. Consultant felt she wouldn’t survive mechanical ventilation or CPR so didn’t offer those treatments. She still had excellent ITU care and nursing (and recovered)

I also object to the comment that “many doctors” see patients as taking up bed spaces. I can’t say no one does, because I don’t know all doctors, but the vast, vast majority absolutely have their patients’ best interests at heart.

I’m really sorry to hear your mum is so unwell, hard at the best of times but particularly so right now when hospital visiting and seeing other family for support is so restricted. Really glad you’re getting to see her today.

As others have said, a DNACPR order just says that resuscitation won’t be attempted, so if your mother’s heart was to stop beating she would be allowed to die with dignity rather than going through brutal resuscitation efforts that would be unlikely to bring her back. It doesn’t mean that that any treatments (potentially all treatment including ICU care, dialysis etc if this was thought likely to help) apart from CPR will be offered.

The decision not to give CPR is a medical one and in my opinion (intensive care doctor) the decision whether a patient should have CPR or not should be made for every patient when they’re admitted to hospital and re-assessed throughout their admission and I think since covid this is happening more and more - having the discussion should not imply that the patient is potentially coming to the end of their life but that everyone knows and understands that for patient x, CPR would be a horrendous thing to put them through that almost certainly wouldn’t work, and for patient y, CPR would still be horrendous but has a hope of working and leaving them with a good quality of life afterwards. On a positive note, I’ve been involved in discussions with families regarding limitations of treatment (no CPR, no ICU and so on) and many of these patients have subsequently been discharged from hospital and are still going strong but know that when they reach the end of their life no one is going to carry out futile, painful and distressing treatment.

Doctors absolutely do not view patients as just taking up beds.

I too have reported that post as its extremely offensive

I didn't think her post was offensive, and I could say more, but that doesn't help the OP.

@PersephoneandHades your post is offensive to medical professionals and I've reported it.

OP, it is a clinical decision. Ethics state that your mother's best interests drive this decision. That does not equate to your best interests.

Please do some reading before you visit your mother.

Very sorry to hear she's so unwell.

Following as we have had the same issue recently with an elderly relative. 83 with various lung issues but all there mentally. She told the doctors she did NOT want a DNR. When she was discharged, they found a DNR letter in her file.

Yes you can oppose them putting a DNR in place. I don’t want to dampen the mood but doctors do not always put the patient first, many doctors simply see a patient as taking up bed space and do not want to waste money and resources on older people. This happened with my grandma to the point where we had grounds to sue and the hospital she was in had a rule legally changed to ensure that what happened to her did not happen to other patients.

I am not saying that this is what is happening in your personal situation, but please keep yourself very informed of you and your mother’s rights and do what you think she would have wanted.

This isn't about with drawal of treatment as others have said but its about should her heart stop whether or not they let her die or resuscitate her.

We had this when Mum was nearing her end - in that Dad and Mum had discussed it previously and said no, but with a wider discussion (without Mums input at this point as she wasn't capable) we made the point to Dad that if her heart did stop she had died, CPR would be bringing her back from that to what...(in our case vascular dementia) and that it would be a violent end should it not work and what was wanted above all else was a peaceful passing away.

I think they are maybe prempting things a little early HOWEVER at the moment DNRs are very front of mind due to the nature of Covid 19 which causes clots and strokes which is perhaps why they are asking earlier to get it on record - it doesn't take long to sort but it is an official letter rather than just the three initials on file

Sorry to hear about your DM

Please don’t confuse not attempting resuscitation (DNAR) with withdrawal of treatment they are not the same. The new RESPECT process here makes this clear.
Ask to discuss it again when you go in.

You can't insist as it's a medical decision, but you can absolutely discuss your concerns and emphasise the quality of life your Mum had before this illness. You need to feel all the information has been considered.
Just a thought, was the doctor referring to quality of life before this illness or after should resuscitation happen?
What I mean is for resuscitation to occur your Mum would have to be so overwhelmed by her current illness that her body systems failed and her heart stopped and she died. Even if the resuscitation restarted her heart (which would be unlikely) she would likely be in the same position she was before her heart stopped but probably worse as 'down time' when the heart isn't beating can cause damage to organs including the kidneys and brain. It sounds like the doctor has concerns regarding her quality of life after resuscitation.
I'm sorry if that sounds so bleak.
Whether to resuscitate has nothing to do with the value of the person or their life, it has to do with the possibility of them having a meaningful recovery after. Your Mum's life is worth as much as anyone of any age, but it will come to an end at some point.
I'm sorry you are going through this. Talk and talk to her medical team, make sure you say what you want to say and that you feel all decisions have your Mum's best interests at the heart of them.

Resuscitation is brutal, very very undignified and often does not work. It is not like on TV .
Having a DNAR does not mean that not everything else would be done as they are obviously trying to sort out her medical problems. What it meant is that if she got to the point where her heart stopped because she is so Ill that it can no longer work they would let her have a peaceful death rather than a whole team jumping on her and putting her through a horrendous ordeal at the end.
I am sorry your mum is unwell and I hope they can get on top of the problem soon.

You can absolutely insist on her not having a DNR, and those wishes would be taken into account, however as other posters have said, it would be a clinical decision as to how much intervention would be done.

The problem at the moment is that doctors are having to make these decisions without much other information other than the patient in front of them, but it's absolutely relevant that your mum before her decline was active, and the issue seems to be that they simply don't know what is wrong with her, rather than a condition that would require a significant amount of intervention.

Sorry, when I wrote you can insist I meant you can insist, but the decision will be with medical staff.

A DNR doesn’t mean stopping treatment and having your mum “put out of her misery”, it just means that if her heart were to stop they wouldn’t do CPR.

CPR can be very traumatic for anyone, let alone older people, and can often leave them with life changing injuries if they survive. A DNR is put in place to prevent this.

Of course you can argue it, but look into it thoroughly first and think about your mums quality of life if she was to have broken ribs, or brain damage, or other injuries following brutal resuscitation.

It must have been a shock. I feel for you.

A DNAR is actually called a DNACPR - do not attempt cardio pulmonary resuscitation. It doesn't mean anything about any other treatment.

Your mum will still be treated for other conditions. It just means that if her heart stops, they don't think it's in her best interests to try to resuscitate. Chest compressions are brutal and nothing like shown on TV, so if resuscitation was successful (and it only has a low survival rate) it's hard to recover from.

You can’t insist she is resuscitated if the medical decision is that it’s a futile treatment . But you can insist it’s discussed with you again and poor quality of life now should not be the reason why it’s withheld unless everyone is confident that’s what your mum wants / is in her best interests. You could also ask for a second opinion.
I’m sorry you’re in this position. Resuscitation is a brutal treatment with very poor success rates when there isn’t a reversible cause of the arrest. So it’s great if, for example, you have a heart attack and your heart rhythm becomes abnormal but can be shocked back to normal. Useless if you are dying of an underlying illness process which can’t be fixed. It may be that’s what they think is happening for your mum and hence the discussion around DNACPR. But it sounds like you need to talk through this more st the very least and you should have the chance to do that