To at least have discussed DNR decision with family

[parno]

Been to a meeting today with social services re: dad moving into nursing home from hospital. At the end of the meeting the ward sister took me and my brother to oneside and told us there was a do not rescusitate order on my Dad's notes. Apparently the consultant has taken this decision without any consultation with either dad or family. Dad is not on end of life pathway but has a progressive illness, though not expected to die in the near future.

Is this out of order or am I just being naive?

Is there any way your dad could have discussed it with the consultant?
I'm sorry bout your dad's illness, it's hard when your parents' health starts to go downhill

I'm so sorry! I just retread your OP and saw it hadn't been discussed with your dad-I clearly missed that bit.

I don't think it is unreasonable to question the reasons behind the consultant's decision.
It does sound like the consultant has got a bit ahead of himself and needs to be asked to justify, and possibly amend the DNR, depending on the patient's wishes.

I think it's out of order, but that's based in my own experiences of this with my gran. She was homed as she couldn't look after herself, the body was failing but her mind was totally there. Hospital consultant put a DNR in her file. We fought hard to get this removed. Whilst she was lucid enough we felt this decision should be hers and she certainly didn't want to not be resuscitated. We finally reinstated it 7 years later when the body was in a very bad state and her mind was also pretty much gone. She died within a few months then, but we felt it cruel at that stage to keep her going.

If your father wouldn't want this then fight to get it removed.

Are you sure the consultant is allowed to do that? To just take it upon themselves to decide that?

My grandad had cancer and we were caring for him at his home. His doctor came to see him and talked about dnr and made sure he understood that he wasn't going to get better and what would happen and made sure that he had my grandad's explicit agreement for the dnr.

It was very upsetting to listen to, but I thought vital for the doctor to do. I am staggered to learn that a doctor can just decide it unilaterally and simply tell you this is how it's going to be.

There is a huge stir about this very issue in the papers at the moment. I am stunned the consultant is not aware of this and being more cautious. It's a very hot topic.

YANBU.

I'm sorry that you've found yourself in this awful position.

Looking at it from a professional view- I've seen this done many times over the years in an emergency situation when death is imminent and relatives aren't around. CPR obviously isn't always in the patients best interest and can be considered really cruel if you know the outcome is going to be bleak anyway.

However, your situation sounds different in the fact that your poor dad isn't on "deaths door" I would ask to meet the consultant to discuss your concerns.

Hope you all reach a decision that you're happier with

Good luck......

You may be interested in this debate we've been having elsewhere OP, lots of info about the legalities and ethics of DNR: www.mumsnet.com/Talk/in_the_news/1563091-to-think-this-is-disgusting-and-wrong

DNR is a medical decision taken by doctors. It is taken objectively based on the likelihood of a positive outcome. It means only that if a patient's heart should stop beating, heroic attempts to restart it will not be made.

It does not mean or imply that any other form of treatment will be withdrawn or withheld.

A patient may request that a DNR note be added to their records.

the reason the nurse told you seems obvious...she didn't agree with the dnr.
I really think families need to discuss these matters well in advance as when the time comes other family members may disagree, and they may go against the persons wishes.

carabos has said everything I was going to say.

I have done CPR in hospital hundreds of time. I have seen someone recover to the point of going home ONCE. Why can't we let old people die with dignity and comfortably instead of making doctors and nurses jump on their chest, breaking their ribs, inserting them with tubes into their throat and veins (and often missing because it is really difficult in someone who has arrested) in an almost entirely universally futile effort?

Speak to the consultant, ask why this has been done for your own peace of mind, but be reassured that this doesn't mean that your father is going to be stuck in a room to wait to die. It just means that this completely inappropriate treatment is not going to be offered and he will be allowed to die a natural death.

OP

Would you want your dad to be resuscitated?

Resus is brutal - there is no other word for it. It is nothing like it is shown on TV. It is undignified and for most people it does not work.

In an elderly person it is very rare that it works.

I would not want any of my older relatives resuscitated.

Carbos said what I wanted to say.

I don't think DNR should be discussed with family at a stage like this because it's very emotive. Obviously no one is going to blame the family for doing so, but most will not want people to stop until they've resuscitated.
It should be discussed with your father though, without a doubt. Especially as you say he isn't near the end of his life.

I've seen instances were families have insisted on resus, on 98 year old women who are being kept alive by drugs alone. I completely understand, they dont want to lose their loved on but in cases like that to let them go is for the best.

Sorry you're in this situation x

What bartlet says, it's a horrible procedure that more oftern than not doesn't work. If your father is going into a nursing home it is even less likely to work as all we can do is CPR until an ambulance arrives and takes the patient to hospital.

Even if it did work what happens then? You have to watch your father die from a progressive illness, and your father has to suffer through it. I'd think carefully about taking it off. Chances are it won't be needed until his condition has deteriorated anyway. I'm sorry that you and your family are going through this

It is important I feel, that DNR orders are in place before that urgent, middle-of-the-night crisis deterioration when junior doctors who have no choice but to resuscitate someone who should never have been resuscitated

that poor person may end up on a ventilator and end their days thus

how is that better than letting someone die with dignity ?

I think people also need to be truly aware of what a DNR order really consists of, there is a lot of ignorance about this

You should aks the hospital for an explanation of why there is the DNR, but please do remember that Resus rarely works and if done right will be invasive and will involve breaking his ribs (a painful injury he may never recover from at his age).

I agree that the hospital should have discussed this with you - if it was my father I would at least want to be informed of the decision and reasoning, if only so that I could come to accept it.

We should be blaming Holby City and Casualty (hypocritically, I do watch them both ) for this, not Consultants in hospitals.

On these programmes you see someone 'arrest'. Then you see a cute doctor or nurse pressing their hands gently against a person's chest and a cute doctor or nurse giving an oxygen chamber a quick squeeze every so often, the patient coughs then they're speaking again. Or, the patient dies, but there's an appropriate pause for everyone to look soulfully at the ceiling.

The reality is that CPR involves huge effort, is brutal, and very very rarely works.

I once worked as a care assistant, and because no-one had managed to discuss DNR with a relative, CPR had to proceed. I watched the patient die. Twice. They died the first time, then the doctors brought him back to die again. I spent his dying minutes trying to clean his blood and body fluids from his body to give him a little dignity in death, and to save his wife the trauma of witnessing the effects of 'intervention'.

Why do people not get informed of the realities of medicine? We still think that doctors are miracle workers, that they can save all, and if they don't manage with your relative, they were lazy.

It is just like the situation in neonatal care. People see 22 weekers living, and think that means that all 22 weekers would live if only the doctors and nurses worked hard enough. The reality is that even 27 weekers are at significant risk of SN as a result of their prematurity.

Every medical decision will have consequences, and we need to stop thinking that Doctors are miracle workers.

If a person in their 80s is successfully resuscitated, then the likelihood will be that they have broken ribs as a result. The natural consequence of that could well be pneumonia, then you have to remember that there was a reason that they arrested in the first place!

My dad is also in a nursing home.
He has a DNR on his notes but it was done with mine and My Dsis's consent. I'm not sure how I would have felt if it had just been put on by the doctor.
However, I don't really think he would want to be living in the state he is at the moment if he was aware.

As heartbreaking as it may be for relatives, just because doctors can intervene doesn't mean that they should.

"Why do people not get informed of the realities of medicine?"

Why do medics not discuss DNRs with people?

That's the real question.

This thread is reaffirming me in my decision to take a short trip to Switzerland if my condition progresses (or take my life comfortably at home if I can manage it). Because it will be the only control I have left.

If I could trust medics to discuss DNR - or any other medical decision - with me, I would almost certainly choose it. But apparently many won't feel the need to consult me in the matter of my own death.

I have during a previous bad period been very dependent on others, unable to speak clearly and only able to think slowly (but still able to think and indeed post on MN). It wasn't very nice, but the worst bit - worse than pain - was other people treating me as though I were an animal. A pet to be treated kindly and fed and watered and talked about as though I weren't in the room, but not a human being.

When I have so little of myself left, intellect and self-determination are pretty much the only things still making me human. If some other human being - my equal, remember? - tries to take those away from me, they are taking away what's left of my humanity. I become just a warehoused piece of meat.

So when you lovely medics write "DNR" on the notes of a capable patient without their consent, you're not giving them dignity. You're taking it away.

GMC Consent guidance: Presumption of capacity:

64. You must work on the presumption that every adult patient has the capacity to make decisions about their care, and to decide whether to agree to, or refuse, an examination, investigation or treatment. You must only regard a patient as lacking capacity once it is clear that, having been given all appropriate help and support, they cannot understand, retain, use or weigh up the information needed to make that decision, or communicate their wishes.

65. You must not assume that a patient lacks capacity to make a decision solely because of their age, disability, appearance, behaviour, medical condition (including mental illness), their beliefs, their apparent inability to communicate, or the fact that they make a decision that you disagree with.

nurseneedshelp - this was the reason we reinstated gran's DNR several years later. We all as a family decided it was too brutal for her at that stage. My dad signed it and when she died a few months later he felt like he had signed her death warrant. But we all believed that it was the right thing at that time.

When the hospital chose it, as brutal as resus is, it wasnt the right choice for my gran. She may have been in her 90s but she was fully lucid and did not want to die. She'd never been ill before this point other than coughs and colds. One of the biggest objectors to this enforced DNR was my sister who is a radiographer so is fully aware of what resus damage can do. My gran wasn't a nice person and had been nasty to the staff but they'd tried to hide the fact she had c-diff, then added this to her file and when she finally got homed they banned her and refused to administer any emergency treatment.

Whilst I don't doubt in most cases this would have been added for the patients benefit, it should at least be discussed with family first.

Thank you for responses. TBH after having had a day to calm down I don't think I oppose the DNR status. I just object to the way it has been done. I know for definate that it has not been discussed with Dad. I have asked the responsible Trust for their DNR policy to see what it says about the process for DNR'ing a patient. Dad has been deemed to have enough capacity to decide he wants to go into a NH but the consultant felt it wasn't appropriate to involve anyone in the DNR decision.

I just want what is best for him and to do what he wants. I want him to die with some level of dignity when the time comes and agree that resus isn't necessarily the right road to go down. Am going to disappear over to the Elderley parents page to have a right good cry.

Thanks again for advice and words of support.

It's a difficult situation. I work in elderly care and I actually challenged a consultant about it - I asked him if he a. Would discuss it with the patient and b. if he should? He said he probably should but obviously it's a difficult issue to raise and they don't want patients to assume they will pass away with us (most people are very nervous in being admitted!). But pratically, there are fair arguments above about the success of CPR, particularly in older people. Anyone who has been resuscitated doesn't have as good a quality of life as they did prior to the arrest and they make the medical decision on the impact of the individual versus the likelihood of success.

I think they should have told you before he was about to leave! But I'm glad do hear you saying you just want what's best for him. I hope he settles in well to the nursing home.

I am really sorry about your dad x