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?

I agree that they should be talking to your Dad about this . Do you have medical power of attorney?
When my late Mum decided to have it, she was asked really regularly to check this was still her view. I remember queuing up at her GP's to hand her latest form in after she had signed it. Again. It broke my heart waiting and thinking about the significance of what I was holding but I respected her views.
She died peacefully in a hospice shortly after with all her kids around her and some adult grandchildren too.

When my husband was in A&E rhesus, someone in the next cubicle went into cardiac arrest. Hearing him have cpr including shocks and adrenaline and seeing everyone running, around over a period of about 20 minutes until they gave up, convinced me to sign a dnr for my husband, and he died very peacefully a few weeks later. I would never ever want to see anyone I loved and who was at the latter end of their natural life go through what they did to that poor man in the next cubicle. Maybe someone younger who had decades ahead of them if revived, if they had been in an accident maybe.

So sorry, OP. My dad refused a DNAR. He was in a care home when he died, aged 99. They did CPR which meant he had an undignified, violent death. Three years later it still haunts me.

OP I'm so sorry if I sounded blunt... that was not my intent at all and my heart goes out to you at this difficult time.

One of my close relatives passed away at home from heart issues but an ambulance was called and they managed to resuscitate him. However he never regained consciousness so he spent the next two days in intensive care being support by machines and medicine. This situation prolonged the death for everyone involved, family members stayed 24 hours until the moment he died, distraught and scared. I loved him with all my heart but I didn't like seeing him intubated and basically in a coma.

He was 85 and should have been allowed to have passed away in peace at home like he did without the further trauma that occurred never mind resources that were wasted.

So yes a DNR would have been best in this situation.

To some a DNR sounds like giving up but in reality it is allowing a more dignified peaceful death. As the previous poster said watching/hearing attempts to resuscitate is not nice and the people DNR is suggested for are unlikely to come back with CPR etc etc anyway but they have to go through the trauma.
DNR makes sense

We chose not a DNR when my grandad was hospitalised along with no ventilation. It was a hard decision but the chances of him actually surviving and improving due to various medical conditions were so slow we decided that he should be allowed to die peacefully and with dignity. We have never regretted it, he didn't live very long after we made these decisions but he slowly slipped away. They carried on fluids and pain relief etc until the end, he still got brilliant care. to you OP

Sorry that should read we chose a DNR

My late husband became very ill very quickly. I was asked if I would consider DNR. I asked the Doctors should he be resuscitated would they be able to give him an extended period of reasonable life. They couldn't, so I decided that while I didn't want him to go (obviously) it was in his best interests to be allowed to slip away. I take comfort from this now.

It's a horrible decision to make OP and my heart hurts for you but let him go without CPR.

100% chance of a "dignified" death or a 1% chance of a bit more time with my family and some bruising and cracked ribs? I'd go for the latter. After the debacle of the "Liverpool Care Pathway" with older people being denied water I don't trust hospitals one iota. I made it very clear when my husband was admitted with suspected heart problems that I would be making a contemporaneous note of all conversations which staff would be asked to sign and that I would be photographing and sending to CQC any indications of neglect or unclean surroundings. I also indicated that if there were any grounds at all I would sue them as an organisation and as individuals. I was very unpopular but it was necessary for him to be safe. I am not the only person I know with legal training who has taken this approach.

As a HCP who has performed CPR on a lot of elderly or frail patients, I can give you a brutally honest view of what it's like and why it's never, ever appropriate. If you're not up for that and you'll find it upsetting, don't read the rest, just read this and the last paragraph.

In my entire career and that of my colleagues, I've never successfully revived a patient over 80 and over 70, I've never known anyone get back to normal health.

I'd say about 85% of cases over 70 but under 80 who have had CPR I've known have died within the year and probably 60% of all CPR patients over 70 have suffered some kind of lasting injury from the CPR itself.

In the over 80's, CPR is utterly traumatic. At that point it's very very easy to break ribs/ cause internal bleeding through CPR. Hearing ribs crack as you're doing compressions is horrific, but you have to continue doing compressions which you KNOW is causing further damage the whole time but there's nothing you can do.

When HCP's talk about someone 'coming back' on TV, you often picture someone waking up and coughing then thanking everyone etc etc. This does not happen. Ever. Most of the time, a successful CPR means regaining a heart beat, NOT the patient waking up and being well. Depending how long a patient is down for, the brain is starved of o2 which causes brain cells to die off very very quickly. In my experience, the most common post-CPR complications are brain function. Bones will heal (albeit incredibly slowly) but brains at that age dont.

Even when your patient is young and fit, CPR is horrific. To do it to a man who is already confused and frail is, in my opinion, cruel.

Sorry if that was a bit blunt. So the benefits of a DNAR are that you won't subject your father to an incredibly brutal process at his most vulnerable time, where the likelihood of it's success in allowing him to live a longer life with no consequences is close to 0%. The likely outlook if he had CPR and recovered is spending his last few hours/ days/ months increasingly confused, in pain and probably in hospital for the majority of it. Quality of life post-CPR for the elderly is not positive.

You should be talking this through with him, it's his decision ultimately if he's well enough to understand but as a family, I wouldn't suggest encouraging him.

@Sweetheart

The Guardian article linked above by UterusUterusGhali is very informative & should be helpful to you. Sorry you're in this position

'CPR rarely works – why do people have so much faith in it?
'Misconception about this brutal, usually unsuccessful procedure abounds. It’s up to doctors like me to tell the truth'

www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2018/jun/04/cpr-misconception-death-doctors

Thanks bumfluf - we were told that it was 'brutal' for mum and her GP went ballistic at the hospital for doing it. She would have been furious!

I'm so sorry that you're in this position, it's an awful position to be. You musn't feel guilty or like you're letting anyone down - it's his best interests as well as what would be what he want.

I'm not medical, however my sister in law is a GP and was included when our family was in this position.

My Grandad has a DNR applied to him and has had for approx 2 years now as we didn't expect for him to be coming out of hospital when it was applied as he was essentially curled in a foetal position and non responsive.

He came through it but he absolutely has no quality of life, he stares into space almost 24/7 and is confined to a chair/bed and moved with a hoist from his wheelchair into each. He's blind in one eye (as a lasting result of a hemorrhage from his CPR when he was worked on for 45 mins after his first major fit and has limited sight of approx 10% in his other eye. He can't even see his food or pour himself a drink and is utterly miserable.

My sister in law explained that Grandad would likely not survive CPR and that it's not a case of 'CLEAR!' shock Patient now awake and talking et al as Casualty/Holby show etc - it's incredibly brutal and cracks ribs and more. It also doesn't necessarily mean your person will be back as they are now. It's horrific to watch and to administer. It was definitely the right choice for him.

Lots of love to you, your dad and your family x

100% chance of a "dignified" death or a 1% chance of a bit more time with my family and some bruising and cracked ribs? I'd go for the latter.

It's actually more like 100% chance of a dignified death or a 0.1% chance of a bit more time with family (a few hours usually, maybe a few days) and some cracked ribs, a 99% of death anyway but with the added trauma the CPR would have for your family and a 0.9% chance of successful CPR resulting in coma or confusion, or double incontinence and confusion, dementia, additional stroke, additional heart attacks, death within a couple of days after days of pain/ confusion/ incontinence/ infection.

If you're willing to take those odds that's a very personal decision, but it shouldn't be presented as a 1% chance of everything being ok, it's far from that.

I am a nurse and worked in intensive care for many years. DNR just means if his heart stops they would not start cardio pulmonary resusitation to try and start his heart beating again. It is most likely in the doctors consideration to be futile and not in your fathers best interests. If CPR is succesful, usually patients have a long protracted stay on intensive care, and many do not get off life support again and it can be very distressing for patients and the family. It does not mean they will withdraw or stop treatment. Mortality and morbidity following CPR is very high.

I used to be on the hospital cardiac arrest team, and probably 75% or more of those that were still for resus shouldn't have been. Its not dignified, its brutal. If a person is in a shockable rhythm with reversible causes it can be succesful, but on the whole it if the person survies they are in a worse position than they were in before and don't survive past a further 24 hours.

During a cardiac arrest, usually all covers are removed, the patient is exposed and doctors are attempting to place IV lines, take bloods, give drugs etc at all angles. In a dignified death, patients are symptom managed and the aim is to have a peaceful death. All the while someone will be doing chest compressions and a doctor will be trying to secure an airway.

It is good the team have discussed it with you to prepare for what might happen, but actually in terms of law and ethics the doctors and team can act in what they believe to be the patients best interests and don't need your prior consent to do so. They are doing what they should but it is not your decision to make (in legal terms). In terms of in the event of a cardiac arrest the patient no longer has capacity, so by law the doctors can treat that patient at that time in the way they feel is in their best interests. This topic is always very emotional as no one wants their loved ones to die. But personally from a lot of experience a resusitation can lead to a more painful undignified death.

I would ask the team in terms of ongoing support what they will do: ie. will they continue antibiotics if needed, start new meds if needed, give hydration, nutrtion etc just not try and restart his heart if it stops. And aim to allow him to have treatment for his condition but to allow him peace and dignity. He might improve, and then it can be reviewed. DNR statuses have to be reveiwed regularly and can be reversed at any stage.

So sorry, next of kin/family will need to make this difficult decision, if your Dad is confused.

My wonderful Uncle had DNR form in his flat, every time I used to visit him I could see it out of the corner of my eye, the thought of it did upset me, but it was his choice. He died in hospital and was given fantastic, respectful, end of life care.

I miss him everyday, but I know the DNR was the best decision for him.

My dad had a dnr. He was very ill. The nurse told us that their job was to keep him at ease and to make sure he was comfortable and not in any pain. I dont think i would have liked to have seen my dad go through cpr. The way he passed away was peaceful and right.

It is horrible to have to make that decision. Mainly because you know that if anything happens that will be the end. No coming back. However on the other hand what are they coming back to.

Just to put this out there - we don’t know what’s going on with your father but having any discussions about DNR doesn’t necessarily mean that the doctors think your father will pass away, it’s just in the event of worst case scenario. Please don’t think that as soon as it’s signed he automatically won’t be actively medically treated, clarify this with the doctors to make sure you’re always kept informed of any changes in his care.

One of my cousins had CPR and was in agony after that. She had never felt anything like it. They tend to break a lot of ribs, bruise your body and in the end they had to perform surgery as well. She was really young and fit (in her 30s) so thankfully it gave her the chance to have a life again (after many months).

My ex MIL found a DNR in her medical notes after a particularly ill time in the hospital. She questioned it (furious doesn't cut it) and they expkained that given her state at the time if she would have had a heart attack, even if CPR worked it would have happened again within weeks so they would only prolong her life to give her a lot of suffering by giving her CPR. After explanation she agreed with them. This was years ago in a different country though.

Out of all the arrest calls I've ever attended, only one person has survived (a previously fit person in their 30s) and they suffered with long-term brain damage after being under for so long.

Talk to the team about treatment escalation e.g. are IV antibiotics/fluids appropriate. Would non-invasive ventilation be appropriate or artificial feeding. But maybe ITU support may not be. Get the advice from the team looking after him.

DNAR doesn't mean no treatment, but it will stop a 70kg med reg from jumping on his chest if his heart was to stop in the middle of the night.

As my husbands guardian (after an rta left him with significant brain damage), I was asked to complete a DNR form on his behalf.
I was already aware of what it meant, and how brutal CPR can be, and having read all the comments on this thread, I am confident I made the right decision for him when I agreed to sign.
In the end, it didn’t matter, and CPR couldn’t have been done anyway.

do you feel able enough to ask the doctor for a chat.or many of the nurses know certain things on their wards so they could answer for you or at least talk it through and just go over any worries your having.no questions are too silly or too much bother.no matter what you need to say go and make sure you do so.your peace of mind at this point is just as important.and your head must be all over the place.
so even if its to ask the docs why they are advising it.
im so sorry your going through this.
don't put any decision you do make into question.you will make the right decision at the time so don't blame or over think it afterwards.you love them.you don't want them to go but neither do you want them in pain so its a scarily tough thing to even be asked to think about.your ok though.you will do the best believe in that.

Thank you for all the comments a view points. It has been enlightening. Sorry for all of you that have gone through the same thing. X

So sorry you are having to go through this OP

Lots of good advice and information on this thread already, but I’ll add my bit. I’m a HCP who looks after the elderly (over 75). I’ve been involved in consulting patients and relatives about dnar orders, and have resuscitated people.

The general public’s perception on cpr is based on what they see on medical programmes on TV (understandably). Unfortunately, these are usually wildly inaccurate. Most people think cpr has a success rate of around 50 percent.

CPR was designed as a rescue treatment for young, otherwise fit people having a cardiac arrest after a heart attack or during a cardiac procedure. These people usually have a cardiac arrest caused by a type of abnormal heart rhythm that they can be shocked out of. The success rate in this sort of patient is in the region of 40 percent iirc.

Older, frailer people with other medical problems usually experience a cardiac arrest (heart stopping) as part of the dying process, and do not usually have a rhythm that can be shocked. Success rates are around 10 percent (for restarting the circulation - even if only for a few mins). It does not mean survival until leaving the hospital or being neurologically the same.

Surivial to discharge from hospital with no long term damage in this group of patients is less than 1 percent.

Lots of information about CPR as a procedure already on the thread so I will not repeat that.

The medical team are legally bound to discuss CPR with patients (or their relatives if they cannot engage in the conversation themselves). They are trying to establish your views and the views your dad would have had (with all the information). They are not asking you to make the decision - it is made by the clinical team looking after him.

Sorry if ehat I’ve said is unduly harsh; I hope it’s helpful and wish you and your dad the best