DNR ..who’s decision?

[Winterpetal]

I have LPOA for relative in a care home
relative has good quality of life
care home has phoned me to say the doctor has put DNR on relatives notes and they need me to come in to sign the paperwork.
i have had LPOA for past 4 years and always said no to this when asked .
this is a relatively new rest home ,relative has moved to ,and now it seems I’m not getting a choice about DNR.
i have said I’m not happy about it ,but I’ve had 2 phone calls this week asking me to come in to sign the paperwork.
can the doctor and care home over rule me ?

Hmm I think there may well be some miscommunication here. Patients and/or relatives don’t sign DNACPR forms, only doctors do.

Good info on it here
www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/

What absolutely should have occurred is a discussion with your relative and yourself if you have POA for health and welfare, before one is written.

However, CPR is ultimately a medical decision. Your relative can choose not to be resuscitated in the event of their heart stopping, but they can’t insist on it.

I think you’re going to need to have some further clarification from the home and the GP.

You are not required to sign anything at all, just say no

Well the family should be offended involved in decision making ,but the outcome for someone who needs to be resuscitated is often bleak
Benefits quite a,violent process so.it's something g you need to think about .

Have you asked why they have requested DNR?

Resus is pretty brutal. Well, very brutal. There needs to be an attainable quality of life to justify it.

They aren't quick to suggest DNR- we were told my terminally ill father would be resuscitated if he collapsed at home, unless we had a DNR in place.

Should be involved*

They may have a good quality of life now but, if they were suddenly in need for chest compressions would you actually want them to be put through it?

Older people often suffer broken ribs and can end up with brain damage due to lack of oxygen etc. No one wants their loved one to die but sometimes it really is kinder not to attempt it. The survival rates for all ages following resuscitation are actually shockingly low, it isn’t at all how it’s portrayed on the tv.

dailycaring.com/the-reality-of-cpr-for-seniors-get-the-facts/

Why won't you sign? Cardiopulmonary resuscitation generally doesn't have a successful outcome if people are old, frail and have other health issues. It can be brutal, causing broken ribs and punctured lungs and still not work.
It doesn't stop other treatments and care.

Medical decision, doctors choice. You should be told and involved in the process if possible, but you cannot force doctors to resuscitate a relative if they do not feel it would be in the patients best wishes. There's no paperwork as such for you to sign regarding a DNAR, though I would recommend to speak to the medical team to gain more understanding

sounds like miscommunications you should however be discussing levels of intervention and what supports are reasonable for that person.

Doctors do not need permission to record DNR. I would think that the cure j(me are asking you to sign the paperwork that says they have informed you of the doctor’s decision - not to ask you for YOUR permission.
Out of interest, was this not noted on the LPOA? I know when my MIL completed hers, she stated she didn’t want to be resuscitated or ventilated.

I just want to do the right thing for the relative.
the home definitely want me to sign something regarding the DNR ,as I’ve put of going in ,as I’m not sure

just dont sign. I wouldnt. what do they want you to sign for? If your relative agrees, they can sign it themselves.

I signed a DNR for my parent last year. They were deemed to not have capacity.

It was absolutely the best thing to do. Keeping them alive was only prolonging their suffering and they were late stage terminal.

Can you ask your relative (if they have capacity?) Was it ever discussed?

If they’re happy, with good quality of life then I can see why you would be reluctant. I’ve read through some posts about how brutal resuscitation can be, I’m on the fence. I wouldn’t want a loved one to suffer.

It is a medical decision done in the individual's best interest. CPR is brutal and can often be unsuccessful.

It's not about the quality of life she has now, and wanting her to have more of it. It's about what would happn to her if they did CPR on her.

As others have said, at her age her ribs would be crushed (rib pain is the absolute worst, and in the unlikely event that she lived, she'd be in the worst kind of agony with every breath)

I've been at the hospital several with my six stone hemiplegic mum of nearly 90. They asked every time about DNR. She always said no, and they always, kindly and sensitively, pointed out what it would do to her body and what the after effects would be. But she still refused. Last time I visted her in the care facility I saw a recent DNR in her file. Thank goodness someone convinced her, though I'm as sure as I can be, that no-one would actually have attempted it anyway.

What a difficult situation. Could you perhaps ask the home to arrange for the doctor to telephone you and discuss the matter? Since you have LPOA the doctor should be able to talk to you about it, and explain their reasons.

I hear what your saying but please look into what CPR on someone their age actually looks like and the outcome statistics. Even IF it was sucssesful very likely their quality of life would be dramatically reduced. I have POA for relatives and have asked for a DNAR as it is not something I would put them through, although to be fair their quality of life is not good now.

Don't understand why you wouldn't agree as per lots of responses above

There is a section on the respect form, (include DNR and other medical options) where if the person does not have capacity they have to state who was involved in the discussion.
As LPA you should be involved in talks and documented on the form. It sounds like you should request a meeting with the doctor and talk over options/scenarios and likelihood CPR would be successful. It’s about what is best for the person should their heart stop.
The person it is about should also be involved as much as possible. You definitely shouldn’t be being asked to just sign to say you were there and agree when you haven’t been.

Do you have LPOA for health?
They should really have discussed the DNR with you, but it is the doctor’s decision. Always better to bring the family along with the decision making too though.
Having a DNR doesn’t mean your relative won’t get any medical treatment, just that CPR won’t be attempted in the event of a cardiac arrest. If they are frail it could cause them serious harm. Sorry if this upsets you but it really is brutal. It’s not like on tv when they give you a quick shock and your heart starts beating again. The stats for success and meaningful recovery are really low.

It must have been a shock but go and have a chat with the staff. You could also request a discussion with the GP so they can explain their reasoning.

I think you should do some more research. Doing whats in the best interests of your relative and refusing to agree to a DNR arent necessarily the same thing.

Why can't elderly people be allowed to pass away naturally and peacefully anymore?

I am reading all the messages and taking it all in .
giving me plenty to consider

The decision is not not so much about the nature of resuscitation but whether it would be in your relative’s best interest to have it done. For a start, would it be futile?
when I discuss issues about resuscitation with my patients I frequently talk about what if the heart stops first, and what if it stops last.
The heart stopping first, for example like it suddenly stopping (think about collapsing footballers) or a child or young adult becoming suddenly unwell, then there is often a chance that CPR will be successful.
If you are an older person, maybe with several pre-existing conditions and you are frail and becoming increasingly frail, then the natural
process of someone coming to the end of their life means many of the body’s systems will slowly deteriorate, to a point when finally, the heart will stop. In these cases CPR is futile, because the body has no reserves remaining to sustain living, even if the heart itself could be restarted.
Quality of life for the few, older frail people who are successfully resuscitated is usually worse and the length of their life is usually not lengthened significantly.
It is so, so important to have discussions with relatives, the GP and the care home staff regarding what they would wish for in the event of becoming unwell. This goes beyond just CPR but ceilings of care, such as would they want to be admitted to hospital, would they want to have IV antibiotics etc.
It’s interesting that sometimes older people say they want to have everything going, because they don’t want to upset family. Often frank and open conversations lead to decisions where they say “no thank you, I’d much rather stay at home and remain comfortable”