To think the ressusitation of the over 80s gains very little

[ReallyTired]

I have had several elderly relatives who have had strokes and then been saved by the intervention of modern medicine. They have then suffered a couple years of sheer misery in a nursing home. Their life may have been prolonged, but quality is non existant. Certainly my poor gran keeps saying she wanted to die during the last 18 months of her life. I can't help thinking they would have been happier if they had been allowed to die naturally in the comfort of their own home.

I feel that if we are going to artifically prolong life then we should also have enthanisa for situaitons where prolonging life has been a mistake and caused nothing but misery.

I am not sure what the most ethical way of doing this is. Prehaps elderly people should be encouraged to have a living will to state if they want to be ressusitated or under what kind of circumstances they would want enthanisa.

Somehow we have to have a system to stop greedy relatives from wanting granma killed to save on the nursing home fees.

I agree that if a person expressly wishes a DNR it should be respected. And that, it really is SO individual. My Aunt is 76 but looks about 96, suffers poor health, weighs about 5 stone. I am her next of kin and as, upsetting as it is, if it was my descision then I would say DNR as she has little quality of life.

crescentmoon keeping someone alive isn't always to their benefit though. Sometimes being alive does not equal life.

Or does it?

It's always going to be a controversial topic

Resus an over 80 year old? There is no yes or no answer.

My son has cancer. He has not had a resus because modern medicine means it is being dealt with. But if it recurred, recurred, recurred...would I want him to be treated?

Whole different debate that one.

I shall back out of this thread now. My opinions are all over the place and it is a bit too close to home. Apologies.

My FIL is suffering from cancer at the moment, the past six years have been tough on him. He was involved in a car accident in which a car travelling in the opposite direction came into his side of the road and crashed into him. He was lucky to escape with his life, but spent the next year in hospital. He spent the next five years recovering at home and just started to get back on his feet, after multiple operations. When things started to look up for him he was dealt yet another blow, he was told he had lung disease and probably had only a few years left. Then the final blow came only a short while later in January this year when he was told he was riddled with cancer. He was given only 4-6 weeks to live.

Now, 5 months later he is still with us but in a very bad way, last week we were told by the doctor, after he was called, that it was the beginning of the end. Although FIL seems to have 'perked up' a bit. He constantly has attacks in which he struggles desperately for breath. He tells us that every time he has one of these he feels as though it is the end, but then he recovers. He is bed ridden, on countless pills a day, morphine and oxygen.

FIL often says that he wishes it would just be over as the pain/attacks/constantly struggling for breath are too much, and constantly feeling like he is about to die is horrible. But on the other hand he wants to live as he does not want you leave us and especially as he became a grandad when my DS was born 16 months ago, he wants to see him grow up.

He is only 56.

On the question of euthanasia I would say it is completely up to the individual to decide and no-one else. If they want to die, then why should they be denied the right, after all the government does not 'own' people. We are the property of ourselves. I think living wills/DNR's should have standing in law. But also, longing for death and the will to live can co-exist in some circumstances as with FIL so the question is not always black and white.

Sorry for the long post!

YABU. Who has the right to set a cut-off on a stranger's life?

I definitely agree with DNR orders being given legal status though, and with close relatives being given the choice when someone is unable to give a decision themselves.

I had to sign a DNR form for my Dad. The doctors said he would have no quality of life at all as all his organs were shutting down. If they had asked him he would never have agreed to it. I felt disloyal but it was the best thing for him and I didn't want him to suffer any more.

He went into cardiac arrest and I had to watch him go, the hardest thing ever. Still believe I did the right thing though. Although he was only 67, he was worn out. I definitely agree that people should be made aware that they can ask for DNR status, but it's a very difficult thing to talk about. I could not have said it at the time, although he was lucid. Sometimes other people and doctors have to make the decision.

Horrible topic. It should always be down to the individual and their quality of life. My parents are late 70s/early 80s and both very fit and healthy. My in-laws are 10 years younger and MIL had so many health issues, always in and out of hospital. I know which one has the better quality of life now and would do in the future and it ain't age related.

"Who has the right to decide though?"

I don't understand the need for any debate on this . The individual

Surely no-one except the individual can decide whether they want to continue living or not?

I don't understand what age has to do with it. Really I don't - we don't decide that people who are in wheelchairs or limited mobility or other life long condition have insufficient quality of life and shouldn't be resuscitated if the need arose.

People who are unable to make the decision themselves are a different matter and on the whole (unless demonstrably unreasonable in a court of law) their next of kin should make the decision.

This is an emotive subject for me my Mum died three weeks ago at age 79 she had a grade 4 brain tumour so we knew that she was going to die but the end came sooner than we thought.

My sisters and I had loads of discussions about how we would support Dad when Mum was ill, and certainly DNR was discussed by us as Mum was in no fit state to make her own decisions.

We knew it may have come to a situation where Mum was alive but with no quality of life and we also knew that Dad would have done anything in his power to have kept her alive just so he could see her and touch her and be with her and we needed to take his wishes into consideration luckily we didnt have to make any heartbreaking decisions but we were fully prepared for the possibility.

The problem as I see it is that if DNR is routinely put on a patients notes there will come a time (if it hasnt happened already) when elderly patients will be just left to die not because of their or familiy wishes or quality of life but purely for financial reasons to save the NHS money ( we already have had reports of elderly patients being refused treatments etc due to their age)

I dont know the answer wish I did

to be fair to any doctor I have ever met, I can't think of one who wouldn't resus on cost grounds. A few who wouldn't on quality of life grounds and although that's well intentioned I still would maintain that only the individual and their close family know what quality of life means for them at that point in their life.

Maybe when you know you are in the last weeks of your life the ability to be in the same room as your family is enough - to just be a part of what you made in your life and to know that your presence is enough for your family also. I would happily stay alive with little quality of life for a while if I thought it would help DS .

I would come back and haunt any doctor who decided differently.

It's not something that should be generalised on. Some over 80s are fighting fit, so routinely not resuscitating if they were suddenly struck very ill would be ethically unsound. OTOH, some people are already very poorly in their 60s. Unless someone has consented to DNR, it should be left down to medical factors whether resuscitation should be attempted or not. I think there's already enough of a culture of insisting that old people don't matter because they've had their lives already without formalising it.

My dad died 6 and a half years ago, and had been ill since before I was born. He was told in 1980 that he wouldn't live to see me past 5. He saw me reach 26, because he was resuscitated several times. He was a double amputee who had 9 heart attacks but he had a great life, loads of friends, went to a day centre 3 times a week.

The night he died I had to decide if they should attempt to resusciate. I always remember him saying that he wasn't going to die peacefully, he was going to go kicking and screaming, so I told them to do everything they could. It didn't work but I know I followed his wishes.

This is all a roundabout way of saying YABU, people have the right to decide. If they go for a DNR, fine. If there isn't one, we should presume in favour of life.

My grandmother is 94 and in a bad way. Two years ago she lived on her own in the middle of beautiful countryside with beautiful views from her chair, and was very independent.

Then she fell and it all started to go wrong. She now lives in a nursing home and stares at the wall most of the day. She mostly refuses to leave the home and refuses to interact with any of the other residents or staff. She aches for the life she had, which she can never have again. She also can't read or concentrate on television, audiobooks or radio programmes. It's everything she always said she didn't want.

She broke her hip early last week (the second time this has happened) and has been in dreadful pain, very confused, but has come well through the replacement operation and is back at the home. She alternates between telling us that she wants to go home and that she wants to die. Neither of these things are in her power. Nothing is in her power, which I guess is the crux of the whole thing.

I don't know what the answer is. Just hope that you and your loved ones are lucky I guess. Dh's gran was in a much worse physical condition at the end of her life but lived in a location where it was easier to get help in her own home so she didn't have to move, had a different, more social, personality which made accepting help easier for her somehow, and had a fairly quick decline in the end. It's all the luck of the draw.

I don't see age as a factor - one can be ill and frail at any age. Making an age cut-off would, as ouryve said, just be adding to already sad culture where the elderly are considered less than the rest of us. I can see pushing for every capable adult to make end-of-life type plans and preparations as it will happen and often happens very unexpectantly but making it specific by age or even disability related sends the wrong messages. As Kew says, quality of life can be very subjective particularly for those already in bad health.

My grandad had a stroke at 82. It looked bad at first but now, although his speech is a little laboured and he can't go hiking up mountains any more, he's the same as he always was. He's 84 and has a wonderful quality of life. With a rule like that in place he could have been left to die.

I think YABU.

Also, if you say you can't prolong the lives of the 80+ because they don't have a high enough life quality then what would you do with people who suffer debiliating accidents or have strokes in their 40s? Or children who are born with PMLD?

It's very difficult I think. My mum (nearly 80) has told me that she does not want to be resuscitated if this arises - and she wants me to know this in case the doctors go against her wishes. BUT - how certain can you be of the prognosis? If the doctors said to me, "Every chance of a reasonable quality of life if we try to resuscitate," I don't think I could say, "Don't do it please." But if they went ahead and resuscitated and it want wrong and she turned out to have years of suffering ahead...

This is part of the problem though. It's impossible to know in advance how disabled you will be (and tbh what your actual attitude to disability might be in the event).

You might be "lucky" and still have a good quality of life or you might be unlucky and find your situation intolerable, which unfortunately is tough as things stand and you'd just have to make the best of it.

Which puts the onus on people having to gamble with a DNR as that's the only point at which they have a choice about (possibly, of course resuscitation doesn't always work) continuing their life or not.

Theoretically I can see it being better to allow people to take a chance and then decide "Nah, this is awful. I'd like to die now please."

Realistically, there are too many ethical and practical obstacles for this to ever become legislation.

I do think DNRs should be legally binding and out of the hands of relatives.

There is no way you can make the blanket statement "resuscitation of the over 80s has no point".

People have very different qualities of life at 80 and can recover from illnesses too.

I always try to remember we will all be 80 at some point and will probably then still feel 21 in our heads, I know some very fit 80 year olds and even a couple of fit 90 year olds so I wouldn't write people off just because they are over 80.

I don't think you can generalise. Age isn't a good enough criteria for deciding that someone isn't worth keeping alive.

Kewcumber, sometimes the person themselves are not in a position to decide for themselves though :(

My mil had a brain tumour. She was 59. They operated, and she seems fine post op. The next day though, she had a seizure, and they resuscitated. :(

She then spent the next 4 or 5 month in ITU lurching from one disaster to another (pneumonia, septicaemia, other random, serious infections) She had an infection that was transmitted my touch, so you couldn't touch her. It was clear she was badly brain damaged (directly after the op she had been sitting up in bed, chatting etc, this is all a result of the seizure and ensuing treatments)

She had had the dx and appt for op so quickly they hadn't discussed wishes. and the doctors didn't discuss DNR etc until really a long way down the road. I kept inwardly screaming to just leave her alone, but they kept pumping her full of AB's etc, almost 5 months and she was barely conscious for most of it, and when she was conscious, she was clearly damaged and unable to talk.

crescentmoon, you said "
i think that they should do everything they can to keep someone alive. i think that should be the default."

I think that was the default in mil case. They kept doing everything and I just wished they had left her alone. it was an agonisingly slow death. :( It was, as my little 4 yr old would say, all the way wrong.

You can't decide on resus status according to age.
Only according to the state of the person's health.
There are many 'grey areas' with this issue.
It's difficult for doctors - firstly they are often 'damned if they do, and damned if they don't' - lay people don't always understand the complexities involved in decisions.
Every single patient is different - i don't have a general opinion on resus issues because of that.

I don't think it should be an age thing, but I absolutely believe in Living Wills and euthanasia.

My Grandma had radical cancer surgery at 89 years old, she's 100% recovered and the consultant says she may well have years of good quality life left. She took a big risk having the surgery, but she's tough! An arbitrary age limit on medical care would be a Bad Thing.

I have a very detailed living will. I do not want to suffer. Should I get an awful degenerative condition, I would like the right to die, in my home, with the people I love around me. Currently we don't have that right in this country, which is a shame.

But it gets tricky when you are talking about people who do not have living wills, or who have not made their wishes clear - or indeed, about people who have never been able to do so, for example, babies and children with awful conditions that cause them constant pain.

I think its difficult. People don't want to consider the end and a lot people don't have a will, ever mind a living will.

I think a lot of elderly people are kept artifically alive to please the relatives, rather than for their benefit.

"Also, if you say you can't prolong the lives of the 80+ because they don't have a high enough life quality then what would you do with people who suffer debiliating accidents or have strokes in their 40s? Or children who are born with PMLD?"

I think you have to take these things on a case by case basis. It is really unthinkable to end the life of a child PMLD who is in constant pain. Holland has enthanisa for terminally ill babies. However a lot of children with PMLD are clearly happy and enjoying life. Switzerland allows people to end their lives at the dignas clinic.

I don't want anyone to be murdered, but I think people should have the choice as well. I also think that the patient should be able to have professional councelling to help them make decisions without relatives present.

I think lay people often confuse DNR with do not treat and the 2 things are very different.
Just because an agreement has been reached by those involved, that in the event of cardiac arrest, resus will not be attempted, this does not mean that we won't bother treating your illness either - we'll just stand by and watch you die.
I think that often families are reluctant to agree to DNR because they feel if they do agree then all care and treatment will stop.
Age shouldn't, and usually doesn't, come into it.
And we all have to die sometime so it's not an option.