DNR - is this kind of pressure normal? It makes me very uncomfortable.

It's appalling to keep having this conversation with him when he has capacity and has made his wishes known very, very clearly, multiple times. The last conversation you recounted is beyond the pale. It is quite literally the language of burden and I agree with the pp who spoke about it on the context of assisted dying. This is the reality - the language of burden. I'm glad he's also got you to advocate for him because that kind of pressure is unacceptable.

Apologies OP I now understand your post is about your father’s ICD rather than DNR

In my experience hospitals pressurise ‘elderly’ patients (anyone aged 65) into accepting a DNR.

They claim DNR is a brutal process that an older person cannot withstand.

There are cases where DNR is appropriate but it should be based on clear clinical criteria, rather than being a ‘go to’ for anyone over a certain age.

Against medical advice, and at my insistence, my father was successfully resuscitated aged 86 after being dead for several minutes. He didn’t have a single bruise and lived a further three years with a reasonable quality of life.

Do not be bullied OP

100 this
Only 10% of people survive an arrest
And itu s don't give beds to those with long term chronic conditions

Yes agree @ApiratesaysYarrrvery informative.

That's exactly what we would do (and have done). If and when it becomes clear that someone is ACTIVELY dying, the magnet, which is only kept in a few places, is placed to deactivate it. Really weird discussion by ED.

The only other way this would happen is after the discussion with cardiology, usually in an out-patient setting, and I think in my entire career am only aware of that discussion happening 2 or 3 times.

@ApiratesaysYarrr thank you for that very informative post. Having witnessed my 82 year old DF undergo CPR (not my choice) and not surviving I’m struggling to get through to my brother why it wouldn’t be appropriate for my 88 year old DM who is very definitely frail. I’ve saved your post for my next discussion with him.

My Dad was diagnosed as being terminally ill from cancer, and I found some of the conversations about DNR/Respect forms were very troubling. I think what I realised afterwards is that the Dr/specialist nurse had different from me was no emotional connection to the patient. They see a clear black and white medical situation where any attempts at resuscitation have no benefit whatsoever.

It was said clumsily, I totally agree but I would sit and have a long talk to your Dad about the context of the conversation.

This is awful. I think I'd want to know what policy this advice is based upon? Is it an initiative local to the trust or department or wider? What triggers that advice? Is there a specific age? Is it needs based?

I had an extremely ill family member. At the point DNR decision was suggested, they were mid 70s and terminally ill with multiple complications. Even then, the decision was explained to me in a meeting with every single professional involved in their care - more than 10 people. It was the right decision in this instance but I was very much given a space during this meeting.

I'd also be tempted to ask the next person who suggests this to your dad whether they personally have a rather negative preconception of older people? I know people in their 80s who still work or volunteer, who partake actively in their communities, and who still play vital roles in their families. Just because a person might also require care and assistance it's terrible to assume they don't also have other aspects to their life.

The DNACPR decision is absolutely valid even with the ICD still active. It is only in a small proportion of cases the defib would fire anyway. However, I have seen an ICD go off multiple times when someone is dying and it is not pleasant.

It seems your dad has the capacity to understand all of this, and his ReSPECT form seems very well written and clear. I complete ReSPECT forms regularly, and his one seems to be very clear. Obviously if his condition was to change and he became more unwell the ICD can be reconsidered.

I don't think that's normal, no, and I would seriously think about complaining. It's perfectly sensible for medical staff to discuss resuscitation with people with conditions like your Dad has but definitely not to imply that he is a burden etc.
My experience is pretty much the polar opposite. My sister and I had to ask for treatment to be limited and a DNACPR order to be in place for our Mum when she was in hospital. She was in her mid 80s, very frail, had Alzheimer's disease and had developed kidney failure after falling and breaking her pelvis. They were talking about sending her to ICU! Nobody wanted that and she certainly wouldn't have but we were treated like some kind of criminals who were trying to get rid of her when we suggested that maybe it would be better to just keep her comfortable.
More recently, my MIL was sent home from hospital having been told that she had inoperable cancer but without anyone discussing resuscitation status with her. Again, the family had to push for that to happen and things could have got very unpleasant if they hadn't.
It sounds like the situation has been handled very badly in the OP's father's case but it's just as bad if the conversation isn't had at all.

@lallanagy Have you actually considered the medical reasons that might be behind this? It’s not emotional for doctors. How good would life be after procedures to keep him alive? My DM had the same because the medics thought she could not survive what they needed to do in any meaningful way - ie lead a comfortable life. Who wants suffering or no life at all? These DNR decisions are not about full recovery and having a great end of life. They are about realistic medical outcomes and end of life experience. I think you are being unreasonable. Having said that, no medic discuses this with me regarding my DM but you need to
listen to medical evidence and not pure emotion. They won’t avoid treatment unless it’s hopeless.

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/icds-and-end-of-life

This is an informative article. It makes it clear that deactivation is necessary in the latter stages of life, to avoid a horrible death.

I suspect what the clinical staff are saying is that your father would have died a natural death by now. The alternatives may be very difficulty for him and for you.

Can he actually die with the device in place?!

I would worry that he's had a huge amount of potentially extremely painful outcomes - bowel obstruction, breathing/suffocation - which can result in a horrible death if his heart won't actually stop.

What would that look like? Do you both know?

Completely agree @lallanagy my Dad is much older, does have a DNR but we have never experienced any ageism in how he is treated. He acts far younger, is great fun and a very positive outlook. He too has had a UTI recently (hospitalised) and actually it is the health team who’ve been positive saying ‘this or that can happen and this side effect takes time to resolve and is common whether old or young’.

I opened this thread expecting to say that you were being unreasonable, as many people don’t understand the point in a DNR. That is clearly not the case here and I’m shocked, you are not being unreasonable at all and your dad clearly has capacity to make this choice. No medical professional should be making the kind of comments that were made to him. I think you should pursue a formal complaint (although the professional concerned will likely deny or ‘not remember’ saying those things, it might put them off doing it again)

Absolutely agree.

Unscrupulous hospital managers would pressurise staff to use assisted dying laws as a way to clear beds.

I am in two minds about this. My late Mum was DNR but I had to keep reminding Doctors of it as you never saw the same Dr twice, her notes were lost on one ocassion, they couldnt find her on their system etc.

She lived (and so did my Father) far far longer than necessary. Both were in a terrible state in the last few years. Mum in particular was very unhappy.

My experience is that the medical professionals pat themselves on the back patching up very elderly people and literally shipping them back to their care homes where they just existed.

In the end a young person at the GP surgery had a very gentle call about not prolonging things. They got End of Life drugs ready for her at the care home rather than running around at the last moment. It was a big thing for a Doctor to arrange and you can bet when the time came it would a weekend of a long Bank Holiday and no on call Doctor would sign it off. It meant when I last spoke to her and asked her whether she was in pain and she said no. They had worked and she was much calmer in her last few days.

She was a tiny woman and one doctor said she wouldnt survive CPR

I find it impossible to believe that that was what was actually said, let alone 3 times - 'he should have the ICD deactivated as he can't sign a DNACPR form without it'.

Firstly usually that conversation is had by the admitting team, not ED. And as I presume cardiology made the decision to put it in, any decisions re: deactivation would be made after a discussion with the patient by cardiology.

Secondly, it's not true he can't sign a DNACPR (nor does he have to, as others have said, it's a medical decision).

As others have said, dnr is a clinical decision and doesn’t need to include the family. That said, it would be nice if they at least discussed it with people , my late mum had a dnr put in place whilst in hospital after a fall, we knew nothing about it until she came home , prior to the fall she was a completely independent 86 year old, hadn’t had any significant illness, hadn’t seen her GP for anything other than vertigo in probably 20 years,for us it wasn’t the dnr, she sadly didn’t pick up after a long lie post fall, it was the total lack of discussion, the fact everyone in the hospital assumed she must have had carers already due to her age and quite honestly the fact that they had zero idea who she was, even told us, after we asked why she was on antibiotics, that it was to treat the uti she had when admitted from the nursing home, she actually lived in her own house.

Resuscitation is a violent process with poor outcomes for people who already have long standing health conditions and care needs.

There is a difference (huge) between not being actively treated for illnesses and infections, and not being resuscitated in the event of a cardiac arrest.

I would much rather be DNR of the odds of recovering are stacked against me. I would always want properly treating though.