Mum given DNR

Theres a lot of confusion about what a DNR is and what that means for the patient. A DNR doesn't mean they're expecting the worst to happen, it's simply a way of saying that IF the worst were to happen ie cardiac arrest that they wouldnt perform CPR. The reasons for this are usually because it is a violent degrading process with a very low likelihood of success and if they were successful how do they then explain to a confused elderly patient that every rib in her body is broken and she will likely suffer another arrest soon.

Think of CPR as a procedure/surgery, they are saying that they dont think it would be worth the suffering to even attempt it and that the effort would be futile. They arent saying that they're expecting this to happen, its discussed with every very ill/elderly patient or their family. It's also discussed thoroughly and documented however even if family disagree its mostly a medical decision made by the medical team, it's not something that family 'decide' on more that they have input into it.

Did you manage to speak to anyone about the DNR? I know it seems shocking to hear about, but like many others have already said, it’s likely to be a kindness. My very unwell FIL ‘could’ have slipped away peacefully with an internal bleed recently, instead they patched him up so he can lie in bed in pain/medicated a while longer.

It's quite delicate and there should be a lot more public information about the area.

It ties in to the low rate of CPR training. When I attended sessions, it was emphasized that the chances are never good - but if someone's heart isn't beating, you are never going to make things worse by trying CPR and AED use, and overall more people will survive if people do give it a go. Then we were all told to push a lot harder ("if you don't hear the ribs crack it's probably not hard enough" or something similar).

I have had 2 relatives have DNAR and if anything I would say they were both OVER-treated in their last days. It's just that when their hearts did finally stop, nobody rushed in and started whacking them to see if they could live another day or two with broken ribs.
By contrast, another relative didn't have it, and his wife (who found him after he passed away in his sleep) was traumatised by the sights and sounds of the paramedics performing CPR on his body.

You have to ask - if somebody cut off their air supply for a minute while jumping on their chest, how well would they recover? It's not about age, or shouldn't be. I have a friend who had a cardiac arrest in the gym and was successfully revived, in his mid 80s.

The annoying thing is that DNAR forms tend to get lost! Had an incident last year when we were asked to "discuss his treatment" and his wife went, "A DNR form was signed when he came in a few months ago!". Honestly.

As others have said a doctor will make, we hope a good decision in the moment about assisting or not breaking someones ribs.
However the need to pull out and get signed dnrs, usually from a vulnerable family member disgusts me.
When most of my family agreed, but I'd hadn't I had a really patronizing nurse try to explain my view away with broken ribs.
Honestly a good doctor will do the right thing in the moment.

It should’ve been discussed with your mum or next
of kin if she’s not able. I’m presuming she’s elderly but generally its a discussion thats
often had with elderly patient when they are in hospital, it doesn’t necessarily mean they think they will need it it’s more of a advanced planning kind of thing to get the patients wishes on paper before they’re in a situation where it is needed. The form these days focuses around what they value too in terms of being at home or in hospital and stuff like that. The chances of CPR being successful and them ‘returning to normal’ in an elderly person is very very small so people often choose to not put themselves and their family through it and go peacefully. It also doesn’t mean that any other treatment wouldn’t be given ie antibiotics, etc.

My Mum recently went into hospital and she’s got copd . She’s 64 . The doctor in A&E mentioned a DNR to me which I questioned later on coz my Sister wasn’t happy about it and when my dm came out of hospital it was on her medical notes to the gp that I had agreed to it ?!! I didn’t agree to no DNR , the doctor told ME about it . My DM has had to challenge them to get it off her records .

Make sure this is what you want for your Mum because this doctor in A&E was sneaky and tried to make out I had made this decision as my DMs NOK .

Why does the OP need to challenge? It’s the OP’s mum who needs to discuss it with doctors if she doesn’t agree, or her husband as NOK. The OP hasn’t said it wasn’t discussed with her parents.

Former hospital doctor here , I could write a really long post but if I’m understanding you OP I think your main concern is whether the doctors think she may die in hospital? I’m sorry if I’ve misinterpreted that.

All patients should, in theory, have a resuscitation ‘status’ and a ceiling of care. Ceiling of care means the most intervention that would be appropriate , for example with some people that means giving antibiotics and trying all medications available but NOT putting them on a ventilator as their body may not be strong enough to come off it.

In reality these conversations only seem to happen in older patients or patients with significant health problems. In some hospitals or areas these conversations don’t happen much at all , which in my personal experience is not a good thing*

From a medical point of view they did the right thing in having that conversation regardless of what the decision would be but as a daughter I can see why this would be upsetting, worrying and a shock. It doesn’t mean they think the worst will happen - it means they’ve (in theory) confirmed her wishes and thought about what would be in her best interest if something unexpected were to suddenly happen.

It sounds like you have a lot on your plate. I hope your DM feels better soon 💐

• just to side track , I worked in Northern Ireland for a few years where in the hospitals I worked there isn’t the ‘culture’ of having these sometimes difficult conversations and I saw many extremely traumatic CPR situations including on frail patients with dementia, someone with end stage liver cancer and so on.

There have been cases of doctors doing this for completely no reason, you need to challenge this.

So hard on you, sending hugs

Every doctor I know would automatically request DNR for themselves or their own relatives. Resuscitation is brutal, and usually ineffective. It does not mean that the patient cannot be given other treatments, if appropriate, but nobody in their right mind would choose resuscitation.

I mean this really kindly. Elderly people having an dnar is absolutely not about killing them off. It’s about letting someone die peacefully and with dignity.
Doing CPR on anybody of any age is brutal. Rarely do people recover. Broken ribs. Hypoxia brain injuries. And ultimately, deaths that just occur later and more painfully for the patient. (And that’s talking about younger seemingly fit people.)
my grandmother is 90. Mobile and independent. Very fit for her age and lives alone. She has a dnar. She’s terrified that she could die in her sleep, we’d find her and be made to resuscitate her. I can’t even imagine having to do that.
I think movies and tv programmes glorify CPR as an easy and heroic thing that people immediately wake up from and continue living their lives. Rarely is this the case I’m afraid. No doctor or nurse I have ever worked with wants to kill off the elderly. We do however see people suffer, being flogged with treatment which is futile, in pain, with no dignity.

So sorry op. You have such a lot in your plate. Re the dnar. This should have been discussed with a family member. Hopefully with your mum too if she has capacity.
all it means is that if her heart stops they won’t restart it. It’s brutal to do cpr on some one. Rarely does it work miraculously like you see on tv. Usually it involves a stay in icu after. But the doctors will still treat your mum as normal. They will continue to treat any infections, give medication to help her get better. Etc. Their aim will be to get her home and back to how she was. The dnar won’t change that. Hopefully someone will be able to talk to you properly tomorrow.
Hope you’re ok and your mum home soon.

It’s quite a shock when you hear DNR mentioned for the first time. I remember being really angry when they suggested it for my dad. But it really means that they wouldn’t do cpr if the heart stopped - so basically if they died naturally. It doesn’t mean that they would stop treating or trying (end of life care does mean that). When they suggested it for my mum a few years later I wasn’t surprised. She was treated in hospital and was discharged.

I have currently just gone through a similar situation myself.

My elderly father had previously refused a DNR. He suffered a ’cardiac event’. He also has many co-existing health issues.

My siblings and I were called into discuss a DNR. They staff were concerned that the process of CPR would ultimately be futile and horrific for my father.I agreed with the medics but my siblings didn’t.

There are different levels of a DNR order. We compromised that if the cardiac cause was reversible they would use a defibrillator but if Dad would not be guaranteed a good quality of life, then the DNR would be a medical decision and they would let Dad die as peacefully as possible.

Dad is currently making a good recovery so the DNR has been removed as his circumstances have changed .

i wish you all well.

@Fluffycloudsfloatinginthesky infection in the body causes confusion, it can come and go but in the elderly being in hospital can make the confusion even worse. If I could have done anything differently I would have insisted on more info from the Dr not just the nurse in charge. What type of infection and is it getting better or worse? My DM also went in after a fall, with a UTI.

I would imagine they asked that because of her age. If I get to 80 and my heart stops I don't want to have people rushing in and breaking my ribs while administering CPR (which is likely to happen) rather than dying quickly and with dignity. They need to find out how people feel about it at the beginning of their hospital stay otherwise if something happens during the stay no one administers unwanted CPR.
I am glad your grandma returned home fit and well, but it is good to plan for the future.

It's not a limitation in her treatment in any way. Even with a DNR they would still try all possible medical interventions.

It doesn't mean they don't think she will fail to recover or improve.

But if she should suffer a cardiac arrest she won't be resuscitated. It is quite brutal especially in older people. It's often hopeless when it reaches that stage and is not a peaceful way to go.

Given what you've said, her condition would need to deteriorate significantly for this to really come into play but it being in place doesn't make that any more likely.

It's an end of life request not lack of a treatment plan.

In all honesty, resuscitation is futile in the majority of cases, and it's an absolutely brutal process that leaves behind broken ribs. Attempting it on an elderly person who already has multiple comorbidities is only going to cause them immense pain and physical damage without any realistic prospect of them regaining any quality of life. A DNAR doesn't mean they won't do anything for the person and will attempt to shuffle them off this mortal coil asap. It becomes relevant if and only if they go into cardiac arrest. They will still receive all other forms of treatment. Just not CPR in the event of cardiac arrest, because it'll hurt them and more crucially, it won't work.

My grandmother was in hospital and the first thing they asked was about DNR, even before they had figured out what was wrong with her 🙄 I feel like there’s so much pressure in the NHS that they are trying to get rid of elderly as soon as they can. It’s really sad. Luckily I was there to advocate for my grandmother and she returned home fit and fine.

I would really query the DNR. I have a strong feeling in a few years time there will be a massive expose in the papers about it all.

If your DF is next of kin they would have/should have discussed with him. The day my late DM was admitted after a fall they called and the first question was about DNR, it threw me totally and I didn’t feel able to make a decision there and then and as far as I knew she wasn’t ill enough to even consider it. Unfortunately her infection turned to sepsis and she died four weeks after going into hospital. Do you know what the infection is? I had no idea my DM had sepsis until a couple of days before she died, as far as I was aware she had a UTI. It was an awful experience. I’m sorry you are in this awful situation.

It's a horrible thing to hear; I went through it with my husband.

Whilst he was not elderly, he was clinically frail and it was explained to me that had the need arisen, resuscitation is a brutal process likely to result in broken bones and other damage and that he was unlikely to have any decent quality of life afterwards - he just wouldn't be strong enough physically to cope with it.

The DNR would only have been invoked if his heart malfunctioned - it wouldn't affect any other treatment etc.

Sorry I've probably got lots of terminology wrong here, I'm just paraphrasing as to how I understood it at the time. It does feel brutal but it can be the kindest thing as resuscitation can be a pretty horrific process and unlikely to have a good outcome.