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 ?

So, I’ve been there with my dm. Dm actually agreed with the dr. She had so many health issues that were making her miserable, including cancers (I say that with an s as she had bowel and then lung much later on) Dm was unwell and pulled me into hospital to tell me she was DNR, but I told her to tell my sibling so they knew too. Sibling was antsy and not seeing her point of view, whereas I made peace with it as it was what she would’ve wanted.
In September dm was rushed to hospital where she had pneumonia and unfortunately we were unable to help her.
The real question is, if your relative becomes unwell and needs resuscitating, what quality of life will they really have?
I’m sure it’s a really difficult decision, but also put yourself in your relatives shoes.

CPR on an elderly person who is coming to the end of life anyway is brutal, possibly painful and undignified and very rarely successful. DNR does not mean stopping treatment or medication or failing to get medical treatment as needed. It is simply letting someone pass away peacefully in their own home, and not performing a needless and distressing and ultimately pointless exercise on them. Please sign it.

'Another chance at living' is a pretty rose tinted view of what could happen if she were put through CPR.

This actually came up in conversation recently with my family member who is an intensive care doctor. It’s actually the doctors choice ultimately; in the same way that a next of kin can’t Inn-act a DNR on a person who stands a good chance of recovery they also can’t refuse one on someone who doesn’t. If there is no DNR in place then the nursing/support team have to start compressions…etc but as soon as the doctor shows up they can, and frequently do, over ride it and allow the patient to pass with dignity.

I think the paperwork is probably just admin for the nursing home so they don’t have to start the resus process just to get over ridden by a doctor.

I think it’s important to remember that a person in need of resus is dead, however briefly, their heart is no longer beating. Whilst the NHS has a duty to prolong life as long as possible it doesn’t have a duty to bring back patients who realistically have little chance of resuming a good quality of life. An otherwise healthy 40yo who has a sudden heart attack vs a frail 94yo in a care home … I fully understand it if I’m honest.

Lots of good points made.

As a healthcare worker I strongly feel the sound of elderly ribs and sternum cracking during chest compressions should be played for relatives who think it's their right to demand CPR in cases where it would be absolutely futile. There are cased where it can be barbaric and traumatising for all involved and more families would agree with sensible decisions if they understood that.

A dnacpr is not a bad thing although it does sound scary... For someone who is frail would you want them to have chest compression. Chest compression often will break ribs and possibly the sternum.

They will still get treatment, antibiotics, fluids, food but it's a decision not to put a person through a brutal event when it would not likely have a positive outcome in the event that their heart stopped.

Compression is difficult and isn't like we see on TV. Often it isn't successful. If we can restart the heart your loved one would have broken ribs, possibly punctured lung, they may suffer a brain injury.

I cared for a young man who was deeply loved by his family. They gave him cpr until an ambulance was able to get there, sadly his brain was deprived of oxygen. He survived but was bed bound and unable to talk coherently. No control of his body. Had no idea who his family was. His family then took the decision to place him in care. I felt so sad for the family. They clearly loved him deeply.

I think have a discussion with the team. A. DNACPR isn't a death sentence. It's about dignity. You aren't sentencing your loved one to death.

Sending hugs. (unmumsnetty ones of course)

You don’t have to agree if you think that your relative wouldn’t have wanted it.

It's a medical decision in the end. They can 'overrule' the family decision if it's not in the patient's best interests.

As people have said, it's very brutal. I blame TV & film for making it look like 6 or 7 light pumps at the chest, a blast of a defibrillator (usually not used - again, not a magic device) and patient sits up with a big gasp of air, everything hunky-dory. All bullshit.

The care home might want you sign an Advanced Care Plan in place of your relative, who doesn't seem to have capacity. It's not just DNACPR but things like religious observances, cremation or burial etc.

My mother requested DNR when She was in the early stages of dementia. Siblings and I had POA. In a care home in the last weeks of her life, we had to state what we wished to happen as she deteriorated.
We opted for her to be made comfortable and hydrated. On her last day she was on morphine. She floated away peacefully in the night which was exactly as she had wished x

My mum signed her ‘purple’ form. I’ve done many resuscitations on elderly people who didn’t have DNR for various reasons, it’s not nice and I cannot remember one person who had a successful outcome. It’s brutal, and traumatic for the patients and all involved, definitely not nice for any onlooker, relatives, other patients, visitors, etc. Discuss with you relative(if they are 60 ignore) if they are 75 plus then reconsider.

The defib is used if a patient is in a shockable rhythm, if they are not they are dead. Sometimes continuing cpr puts a patient in a shockable rhythm, but mostly it doesn’t

Do you really want your relative to have absolutely brutal CPR, when it's most likely to be futile? A DNR doesn't mean no treatment at all. It's just in the event of a cardiac arrest. A friend of mine is in a nursing home. And told me he'd signed one with the GP. I have no doubts it's the right thing for him. And he's always said he never wants to be resuscitated.

I will make sure that my parents, both have them in place when and if they get to that stage. And I will have one for myself as well.

Agreed. I've met several children who had Out of hospital arrests. That were 'successfully' resuscitated. They would all have been better off if it had not succeeded. Their quality of life is nil.

Do you actually realise what CPR is? A person is actually dead and CPR usually involves the person’s ribs being broken as part of it…are you really ok with your frail elderly relative being put through this?
In medicine, just because something CAN be done doesn’t mean it SHOULD be done.

For the record I’ve lost both my parents and agreed with DNR for them both, although it wasn’t an issue in the end

Having lost both parents to dementia I agree 100%

Just reiterating what others have said as this is part of my job.
I'd be interested in knowing what they want you to sign when you go in, as DNR decision is made by the doctor, not the patient. Different bodies use different forms, so there may very well be a form that says that the discussion has been had with the patient or, if they are incapable of giving consent, their NOK. However even if the patient/NOK vehemently disagrees the decision is the doctors. They shouldn't have put anything in place BEFORE discussing with you thought.

DNR does not mean withdrawing or reducing any other care.

As others have said, it can mean the difference (if and when the time comes) between passing away fairly peacefully in a ward/room holding your hand, or being rushed into emergency care alone, pain, panic, etc. for something that may not even work and will often result in ongoing pain due to broken/bruised ribs/not regaining consciousness even if they manage to restart the heart/breathing. I would personally agree to a DNR decision if I was in that position.

It’s to sign that you have been duly informed of the DNR.
A DNR is the doctors decision and you can’t overrule it. No one can, even if the DNR were put on you, you can’t refuse it.
You can ask why, and you can question and file a complaint to have the decision reviewed by another more senior doctor.
But that is it.

Doctors are only ‘recommended’ by NICE guidelines to discuss a DNR with patient or relatives prior to putting one on a patient. It’s not a hard and fast legal requirement.

And yes, it’s happened that some doctors have abused this power. So, if you feel this is an abuse of power, definitely question & complain to get it reviewed.

Resuscitation is brutal and has a very low success rate. I'm almost 55 - if I were to end up in a hospital situation where my life was potentially at risk I'd want a DNR. Quality of life matters more.

Do they have capacity? If not, was this ever discussed before? Resuscitation can be a very traumatic experience for the elderly and/or frail. My understanding is that it often leads to a poor outcome and quality of life is not restored to the level it was at before. With a DNR, if anything happens they will be made comfortable until nature takes it's course, at least that's my understanding.

@Throwncrumbs - yes, exactly. TV bollocks again. Two rounds of 'charging 360' and two minutes later it's tea & toast all round. Nothing remotely like the real thing.