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 wonder if anyone can thrrow some lightmon my situation: My dad died last year, aged 86. He had had copd for years, had heart trouble, also had cancer... He had declined innthe last week, and it turned out to be pneumonia.

He had to be admitted into hospital when the pneumonia got worse/was discovered. At home with the ambulance crew I mentioned he'd want a dnr. .then when he was admitted into hospital I said he'd not want to n be resuscitated. Both times I was told i was jumping the gun a bit. Someone came down from itu who assessed him but she said he'd not be admitted there - so he stayed on the ward. We were told to go home and come back the next day at visiting hours.

In the night he worsened and we were called in. They told us they'd given him cpr but it but it was but it was not survivable and we were to sit with him while he passed away. They said it would be quick - it actually took about 90 mins.

It was his time, I know that. Really he'd had too many years of suffering. But when was my suggestion of dnr dismissed? Why would they do cpr at all? Did his long time passing away basically mean that he he had he had brain function all that time?

Realistically when it came to the end, they wouldn't be able to do it without the actual paper being signed - without it they have to do it in my understanding.

I agree that they never should have done it, nor should they have dismissed you. I wonder if they were pushed for time then and there and not able to talk it through with you properly? I'm so sorry for what happened to your dad my lovely :(

I hope someone with proper medical knowledge can answer it properly for you x

Just regarding some comments about CPR. In my second career I delivered First Aid training (1 day and 3 day course). I done this for about 8 years. The amount of people who assumed that by doing cpr you were bringing the person back to life if they had stopped breathing. People were shocked when I said the chance was small but it was about supplying oxygen to the brain. There is a lot of misconception due to how it's portrayed on television I believe.

for those that need it

Ultimately even if there isn't a dnar in place it will be a medical decision if it comes to it. It's inhumane to attempt rescusitation on a frail sick elderly person.

I’ve had to give cpr many times in my career and of all of those only 1 or 2 have actually been successful. We’ve become rather squeamish about death in recent years and just assume modern medicine can fix everything. However death is completely natural and we can’t avoid it forever - what we can do if we’re lucky is have the ability to chose to not have our final moments marred with the brutality of cpr.

Many times I’ve had to do cpr on an elderly person and it felt so wrong, but without a dnr we have to do it. Then the family’s last vision of their loved one is a caved in chest, a tube down the throat, a io line drilled into their femur and ten covered in their own regurgitate. Horrific. Dnr education is the key. A good site to look at is Compassion in Dying.

You can put in place a living will of what you want so that there is clarity if the worst should happen and you are not in the position to make decisions anymore.

Typed a long post which got lost. To summarise what I was going to say:

You are not being asked to make a decision for your dad, legally you cannot do this. The decision rests with the professional leading your dad's care, I.e his consultant. They are seeking your views on what his opinion would be in order to take this into consideration, but they do not have to perform any form of treatment, including CPR if they feel it is not clinically appropriate.

I hate the lazy way Drs sometimes communicate this with families as it leaves them thinking they need to make a decision.

OP, so sorry about the awful situation you are in. Thank you for asking the question and to all the detailed and sensitive posts, explaining the reality of DNR vs CPR and the options in between.
This really is important education for us all.
Condolences to all who have suffered losses, and OP I wish your Dear Dad comfort and peace

As many people have said, CPR is brutal and undignified, and has a very low success rate in anyone, but particularly older, ill and acutely unwell people. Of the many people I have performed CPR on, only 2 have had a heartbeat restored, neither regained consciousness and both died within a few hours.

In contrast, I have seen plenty of peaceful, calm deaths when we accept that death is the inevitable end of life and it cannot be held back forever.

My Dad had CPR after a cardiac arrest and it was brutal - he was in his early 60s. He didn’t survive, and it was very traumatic for my Mum who heard it all, I arrived after it had all finished. I would have no hesitation in agreeing to a DNR if it was recommended by a doctor in future. My Mum passed very peacefully after falling into a coma which was then managed by a hospice nurse, I know what I personally would prefer.

Sorry to ask a question on another persons thread but I have a similar issue going on with my dad. He has a DNAR in place, he's has end stage Alzheimer's with all the usual issues that goes with it. Last week he turned yellow and blood tests have revealed its due either to a blockage in the gallbladder or maybe a cancer spreading from somewhere else.
In a nutshell the GP agrees nothing can be done for him so he is to be made comfortable. The care home are keeping him in bed but he's still eating and drinking despite being quite jaundiced and lethargic.

Can anyone tell me please how long he may have? He's quite jaundiced but has no other symptoms like nausea or vomiting but he's sleepy. As I say he's eating and drinking ok when it's offered. All the care home will say is he's fine and if he's eating there nothing to worry about.
GP wouldn't say how long either and it's driving me crazy not knowing if we have months, weeks or days. Anyone with a medical background know?

we didnt have one for my grandfather because we were all selfish, we loved him too much to let him go - nevermind his mind was already gone and he hadn't woken up in days, he had two minor strokes then a heart attack, they broke his ribs trying to get him back, which they did - it ws horrific to witness - brutal almost. Never again - we had a dnr straight after and we went peacefully soon after. I (and we as a family) will never forgive myself (ourselves) for what we put him through for our benefit.

I think this is something that needs discussing with your father (if he is able to) and your family.

Good luck OP, and im so sorry for the position you find yourself in.

I’m sorry you’re in this position OP

I worked in elderly medical care for many years. I think the argument for a DNR has been pretty well made but I’ll add one thing..if doctors are saying they think a DNR should be done, they are likely to say the individual would not be a candidate for ICU. On rare occasions I’ve seen CPR be successful, only for ICU to review the patient and refuse them. This means an awful period where the individual needs support to stay alive but will not be offered it. Then it is only a matter of time until they deteriorate and arrest again (usually with a DNR in place). It’s horrible for loved ones to watch. Personally, I’ve chosen DNRs for my loved ones when it’s been suggested as being appropriate. It’s not giving up on someone, it’s just not resuscitating where it’s unrealistic or leaves the individual in an impossible situation.

My father had a dnr due to the fact that if they managed to revive him he would not survive long and it was unlikely to work. I hope you are ok.

OP best wishes to your dad, you and your family.

To others on this thread - this is why everyone should consider and make an End of Life directive and discuss/lodge a copy with their GP. You never alas know what's round the corner and it saves your family mental anguish if they know what you would have wanted. And if you have someone getting frailer in your family, urge them to do it - and get them to consider a mental and financial power of attorney.

As a consultant who has a lot of these conversations (daily) I think your Dad's medical team have put you in a difficult place.

If they believe your Dad is too frail to have a realistic chance of CPR being successful then DNACPR is a medical decision. It is then down to them to inform you, as unfortunately your Dad is currently too confused to be part of the decision, that this is the decision.

You should never be put in the situation of feeling that you have to make the decision yourselves on the part of your Dad.

CPR is never like it is on the TV - as other posters have said it is a horrible, painful, brutal procedure which is very rarely effective and often results in broken bones and distress.

Your Dad may have wanted to live as long as possible but would he really have wanted to live as he is now? Or if he survived a CPR attempt heavily brain damaged?

Sorry to be so blunt when you are having such a horrible time but it is very hard not to be blunt typing it - and often these conversations do get very blunt when taken to the conclusion of 'what did the person really really want?'

I've had to mop up more than my fair share of CPR conversations done badly when families and patients have had it explained in very optimistic terms or been burdened as if they are making the decision themselves and are now tying themselves in knots.

I hope you have found this thread helpful

OP every single medical person on here that has seen or administered CPR on a patient has said how violent and brutal it is. I have done it to many patients and the ones I regret are the elderly ones because it does feel like a form of brutalisation. It's horrific to witness and I can tell you it's pretty horrific to be the one on the chest doing it too.

We are not talking about prolonging a meaningful life - at best, it's a painful short term existence supported by a machine.

CPR has it's uses, but not among the very ill elderly.

TheSpottedZebra I've just read back and seen your post.

If your Dad died in a UK hospital (which is what I am familiar with) I was strongly recommend that you make a complaint about your DNACPR request being dismissed when he was admitted.

Your story reads of an elderly man with advanced disease, who knew his own wishes for end of life care, and having a close family member present to advocate for him, having those wishes dismissed. The chances that CPR would be successful in a man over 80 with cancer and 2 serious co-morbidities and pneumonia were non-existent and a competent assessor should have recognised this, not to mention actually listening to his own views.

Then going forward with an ITU assessment - not appropriate and would have been cruel and distressing treatment, followed by CPR, I think is all treatment contrary to his wishes.

Without asking to see his records you can't know whether he was conscious after the CPR.

However I think the complaint is worthwhile and justified to point out that they ignored the expressed wishes of the patient with respect to his end of life care. Feel free to message me.

Just wanted to say thanks to all the posters who offered up such painful experiences. I’m sorry for what you’ve all been/or are going through.

I had no idea what cpr entails so thank you for enlightening me.

Another medic.

I had vicious and ugly arguments with my aunt & grandfather about DNACPR for my Gran and then repeated them all with my aunt when my Grandfather was dying.

My Gran was especially crazy - she was dying of renal failure. She had already refused dialysis herself. We knew without dialysis she was going to die, she was confused as a result of the renal failure hence no longer being asked to make her own decisions and the doctors and I (I have ICU training) reiterated that with her history she wouldn't be accepted to ICU. There was no point to attempting resuscitating her - she had a condition that she had declined treatment for herself...if by some miracle CPR temporarily worked she would only have arrested again. Made me so angry that my supposedly "educated" relatives couldn't see how ridiculous their view point was.

Fortunately in both cases the medical staff didn't allow my family members to prioritize their needs (after all 94year olds with renal failure are going to live forever) over the person who was dying.

This whole situation was hideous for me as I was still grieving for my own mother who had died (with a DNACPR in place!) 6months previously. I was angry that I had less than half of the time with her that my aunt had enjoyed with her Mother yet at the end my siblings, Dad and I all supported /and in some cases argued that she should not be admitted to ITU or have CPR.

This was an incredibly painful decision to make and despite being "in the business" and having had DNACPR, refusal for ICU and end of life chats lots of times it was still awful. However resuscitation & ICU was not what my Mother would have wanted and was in any event totally pointless. She was dying of an irreversible disease process..

However, we found ourselves in the bizarre situation of persuading some of the medical team about this as they tended to focus on her young age and not how sick she was due to her severe life limiting illness. In this situation the ITU consultants were really helpful and had fairly blunt discussions with the physicians about futility.

Of note like a poster above my Motger tried multiple times to discuss her resuscitation wishes while she could it was brushed of because she wasn't sick enough...she knew she was though. I work in hospital and life to change this culture. I would encourage you to talk about this thread with your families. What do you want??

My siblings hold health PoA for me. They know that if I am incapax I would prefer death to being left cognitively damaged. I accept that not everyone shares my views but this is my view.

CPR cannot stop the slow gradual decline of natural death in the elderly or sick. It is really fucking good when something acute and reversible happens eg. Blocking a major blood vessel, choking but even the it isn't always successful and some survivors pay a high price cognitively.

For the frail, sick or elderly it allows a peaceful death.

DNACPR discussions have forever changed family dynamics for us...although I remain health PoA for my aunt in the even of her losing capacity. Discussing DNACPR for her will be interesting as unless her views change she will want CPR but it is likely not to be in her best interests.

Thespottedzebra

My FIL died of copd after he got worse. It took him almost 11 hours but clearly was unconscious for most of that (thankfully). He was awake for a short time about two hours before he finally went. I have since been told that dying people tend to have a better moment shortly before they go. It's an awful disease. Anything that makes the last process shorter would be so much better. I totally understand that you feel bad that they performed CPR. It's a horrific way to die and quicker is more merciful. Sorry you had to go through this

I had to sign a DNR for my Mum, I found it really distressing, as though I was killing her, but I spoke to the manager of her care home who said “ you have to think of what you’d be bringing her back to, you wouldn’t be getting her back in the same state, she could be much more incapacitated and/or brain damaged, but alive” . I didn’t want that for my Mum. I actually wish we’d had one in place for my Dad, who was shocked back to life only to arrest again. I wish he’d had a more gentle death.

My dad had Alzheimer’s, he’s only 64 but we have a DNACPR on record with his GP. When he was first diagnosed it was recommended we discussed all these types of things as a family so we could decide before he got so bad and he lost all memory function
I have POA because my mum and I decided she was too emotional and too close and would be too scared incase she couldn’t make decisions that needed to be made.