Any medical people around that can explain DNR to me?

[Sweetheart]

My dad is in hospital in very poor health. He is still conscious but very confused. The hospital have asked us as his family to consider a dnr. His dr and nursing team all think he should have one. The dr has told us if he needed cpr he wouldn't survive.

My dad said previously he wanted to live as long as possible.

What are the advantages of having a dnr?

The advantages are a peaceful death, no trauma of attempting cpr.

It doesn’t mean that the care requirements now won’t be met, he can still get fluids, antibiotics and any relevant treatment. It just means that if he stops breathing no action will be taken

I found my mum slipped away peacefully and with little amount of fuss and intervention. The time we spent with her was lovely and personal.

CPR is fucking brutal in a hospital, not like on the telly.

I'm not medical but my grandmother had a DNR. It was absolutely the right decision for her. The advantage for my grandmother was it saved her from further invasive treatment and prolonging of herlife when she was in such poor health and had no quality of life. The advantage from our side was it saved the family having to have a very difficult discussion further down the line about whether to continue treatment or not, when everyone was even more upset as her health continued to deteriorate and we knew we were near the end. I think making that decision earlier when everyone was less emotional and more able to discuss it rationally was easier - although still caused a massive row.

Sorry you are in this position, it is horrible

Its the type of death I would prefer to be honest.

So sorry OP, that's very hard.

I'm not a medical person but have been through this with a relative.

A DNR would mean that if your dad's heartbeat or breathing stopped, they wouldn't try to revive him (so no mouth to mouth / CPR / electric shocks etc).

Your dad's doctors seem to be recommending this because they think it wouldn't work even if they tried. There are quite low success rates in resuscitation even with a younger and fitter patient. It can also leave a patient brain damaged or physically injured.

The risk is that if they tried to resucitate your dad, they might be risking brain or other damage on only a small chance of success. They may also feel that it is likely that his life would only be prolonged for a short period of time, leading to more distress overall.

Ultimately though it's your decision. You might feel like you're better fulfilling your dad's wishes by refusing one. Or you might feel that it's better for him not to be put through the risks when it may only have a small chance of success.

I am so sorry you are in this position with this very hard decision to make, and I wish you and your family all the best.

It means if his heart stops, he won't have a large junior doctor jump on his chest and break his ribs to try and get it going again, with a strong possibility that even if the attempt were successful (which is not very likely) he would never regain consciousness.

However, all other treatment can go ahead full steam.

Shouldn't the hospital be asking my dad about the dnr? It doesn't feel right to be taking that decision for him.

No trauma from cpr . All care is still met and they will still treat any illness. Possibly inquire also about ceiling of care. How far they are willing to treat. Not every patient is suitable for level 2/3 care which is hdu/icu. If it helps write down a list of questions for the doctor. It will never be a silly question. Sorry your in this position

Really interesting article.

If he is confused he may not be able to take the decision himself at the moment - it's quite difficult to understand. I hope he improves and it would be good to talk about it when he does.

If he's confused he is not able to make a rational decision.

When my grandmother was in the same state of health in hospital, the doctor suggested rather firmly what she have a DNR. It was the right decision. She was able to die peacefully without intervention.

Even though he wants to live as long as possible, I think you have to consider quality of life over quantity. If the doctor says he won’t survive CPR what’s the point? It’ll just make things more upsetting for all involved and if he does survive, it will be in a bad state indeed.

Medical science is wonderful but when it’s your time, it’s your time. I know it’s so, so hard but If the doctor is recommending a DNR then please listen to them.

Normally it would be your dad's decision but perhaps as he is confused they feel he lacks the capacity to make it? But you should definitely talk to him if you think he is able to understand and make it for himself.

If your dad is confused then they may decide that he temporary lacks capacity to understand so then will discuss with nok, being you and your family.

If your dad is very confused they might have assessed him as not having sufficient mental capacity to make an informed decision. That should be documented somewhere as they should have done a capacity assessment. If he is deemed not to have capacity then decisions will made in his best interests.

I am not a doctor but I do know a bit about this, and have been involved in multiple resuscitation attempts (including one yesterday evening).

To survive resuscitation you need to be in pretty good shape and for your heart condition to be the main thing that has caused your heart to stop beating. Resuscitation is very very hard on the body - your ribs will be bruised and broken, a strong electrical current is blasted through your heart, and you will be pumped full of strong drugs. It is also very undignified for the patient. So when a doctor recommends a DNAR it is generally because they believe the outcome will be futile (ie the patient won't survive the attempt) or not in the best interests of the patient (if the patient survives they will have a very very poor prognosis anyway).

Having a DNAR means that your father will not go through the indignity of a pointless attempt at resuscitation. It sounds as though resuscitation won't prolong your father's life hence the recommendation of a DNAR.

As pp have said CPR is very distressing to see and for a body to go through. The hospital are asking you to consider what would be best for your father were his heart to stop and have given their opinion that if he were to need CPR it's unlikely it would be successful.

The can be extended and changed to include all sorts of things for example my grandmother hated nebuliser so when we got to this point with her we said no nebs. Some people don't want to be intubated and put on a ventilator but others do.

They can be reviewed if things change and adjusted for new circumstances or they can be withdrawn if you change your mind.

It's a really horrible thing to have to decide the hospital should have people who you are able to talk things through with.

If he's confused as you say, then he wont have capacity to consent. So treatment/care will be made in his best interests.

Are you his next of kin? If so that's why they're asking. If your ddad is confused won't be informed consent, whereas it will be if you sign it.

Medics want to do no harm, so if they're suggesting this, it's because they want to cause the least amount of har possible.

Hoping for peace for you all at this god awful time.

Sorry this is happening to you We had exactly the same with my dad.

I previously thought that a dnr was giving up on someone, until it was properly explained to me. Basically resuscitation is applying extreme force to someone’s chest, which is likely to break ribs and possibly puncture a lung. So it is likely to put the person in a lot of pain. Also, if their heart is stopped for a period of time it is likely to give them brain damage. Therefore, if they survive they are likely to be in a very bad state, with who knows what sort of death awaiting them, and if they die during the procedure they are likely to die in pain.

If there is a dnr in place and their heart just stops, then they are much more likely to experience a pain-free and peaceful death.

Your dad may have said he wanted to live as long as possible, but what sort of life would that mean for him? Also, if his heart stops, he would be effectively dead then, and you would be bringing him back from that, but for what?

I used to think that a dnr was playing God, but now I think that it is playing God to keep someone alive who should really be dead.

My dad passed away peacefully by the way.

I am sorry you have to make this decision.

My mother had decided to have a DNR so when she had her heart attack at home and I dialled 999 and the paramedics came she told them that she did not want treatment. Unfortunately we couldn't find the red piece of paper with her intentions on it so the paramedics rang her dr who confirmed she had a dnr.

My mother did not want to go back into hospital (she had been home for just over a week) and I knew this. The paramedics just gave her pain relief and she died about 20 minutes after the heart attack peacefully in her own bed with me by her side.

Hi OP, it means that if he has a cardiac arrest he won't receive CPR, which fire most frail unwell people is absolutely the right thing, it allows a peaceful death when CPR will not have a benefit.
They should also discuss it with your dad.
It is NOT your decision. It would be cruel to expect you to make such a decision for your dad. The team will be asking your opinion but the overall decision and responsibility is theirs. They have to act in your dad's best interests
for you

Sorry just seen your last post.

You say he is very confused. That means he is not able to make decisions like this. If he is likely to improve to the point of being legally competent then yes it would be his choice.

Were he to recover after you had decided this he could easily revoke it once he was again mentally with it enough for the hospital to be happy he really understood what was be asked.

Ah apologies. They should discuss it with him if he has capacity. If confused they he may not.