To get DNR revoked

[TheoriginalLEM]

Thats it really.

How can i do this?

Unfortunately again IME once you are elderly with multiple complex health issues it’s very difficult to get treatment as Drs ( in hospital) just use the existing problems as an excuse to not do anything very proactive .

What’s your mum’s opinion on this? Presumably she decided she wanted it in the first place.

The DNR will not affect the treatment of her co-morbidities. Her current health status and past medical history will.

Have a meeting with your mother (if not upsetting for her) and whoever is managing her treatment (GP? Hospital consultant?) and discuss with them. However, be aware that doctors can leave it in place regardless of the patient's or familial wishes if they feel it is in the patient's best interests.

Whoatemynuts - i am checking if its possible before i have the conversation with her. Im not sure she really understood when she signed it tbh.

Thank you - i will discuss with my mum

LEM I think the main issue is that you have received poor care- you really have - and because it has coincided with the DNaR being put into place it seems like it's the fault of that, when I truly believe it is just poor communication and poor understanding of the whole situation (from staff) that has led to it. I have a suspicion the care would have been no different had the DNR not existed. When you're up to it do you think you could speak to PALs? I would write all my thoughts down about what happens and what your expectations were now so it all remains fresh.

I haven't been of any help to you at all just mumbled on but thankyou. I just wish I could make it all better and I wish your mum would have been with us because I very much think it would have been a different story. Big hugs xx

What's the problem with her having dessert for dinner?

Enjoy your dessert! Glad she's having a better day!

Yes it can be cancelled. However it is unlikely to be the best option for her. And you may find the doctor's don't feel it should be cancelled. Although families wishes are taken into account it is, mainly, a medical decision.

If the other poster is correct and she has an aneurysm, then a DNR is absolutely the right thing, and shouldn't affect her treatment for any conditions. If you feel it is, then talk to whoever is making these decisions regarding other treatments rather than trying to cancel the form.

What is not happening that you think should be?

Firstly, it is a medical decision as to whether there is any chance of success.

Given what you have posted about your mum's health - dementia, ulcer eroding into an aortic aneurysm amongst other problems, and her age, if her her heart stopped beating and she died, the chances that she could be successfully resuscitated are remote in the extreme.

The chances that she could be successfully resuscitated to the same quality of life that she has now are even more remote.

If she has capacity, and that is not clear either, any decision about wanting to be for CPR is hers to bring up with her doctors. She would need to discuss this with her GP, now she is at home and see if they felt medically there was a chance that she would survive CPR. If they feel there is not, which is overwhelmingly likely what they will think, she would be entitled to a second opinion but be prepared that the second opinion may think the same.

If she doesn't have capacity, you can ask for the same reviews in her best interests but ultimately it may end in the same results.

What comes over to me is that you are not happy with her care, both her personal care and her medical care and would benefit from a sit down discussing having the realistic goals of her medical care explained to you and coming up with a mutually agreed plan.

DNAR is very clearly only regarding resus, not other treatment. Sorry to hear about your Mum.

However if this is the case Given what you have posted about your mum's health - dementia, ulcer eroding into an aortic aneurysm amongst other problems, and her age then I would think very carefully how much active treatment for other things she would want to be put through.

But a DNAR is ultimately a clinician's decision, not that of the patient or their family.

A DNR is a clinical decision made by a medical professional. It should be made after discussion with the patient (and be documented that this discussion occurred) or if the patient has been formally assessed as lacking capacity for this decision then family (if any, if not, an Independent Mental Capacity Advocate) should be consulted, and a best interests decision made and recorded.

In reality, few people survive CPR, even in hospital, and if they do they will wake up in ITU, and need considerable intervention for some time. It is a brutal process, that even the otherwise fittest people will struggle to survive.

However the DNR is simply about whether to perform CPR in the event of her heart stopping. It should not affect other care and treatment. There may be other reasons that they are not giving her treatment that they might otherwise consider, depending on her health conditions, and her wishes, but this should all be separate decisions to the DNR.

It would be worth seeing if you can arrange to speak to her consultant. He/she should be happy to arrange a time to speak to you, and ward staff should be able to facilitate this, or arrange a 'phone call. Do bear in mind though that it will be up to your mother as to whether she is happy for them to discuss her care with you.

A DNR decision should only apply in the event of a cardiac arrest. However many hospitals now have more complex forms that allow patients to record their wishes about how much treatment they would like.

Have you seen your mother’s form?

What treatment do you think she is not receiving? Is it possible that she has chosen not to have it without your knowledge?

If you think that her care is substandard then I would speak to PALS and get it sorted out. I wouldn’t rescind the DNR if she has an aneurysm - it’s the difference between a peaceful, dignified death and dying with your chest exposed, ribs broken, needles being inserted, tube in your throat etc.

There are also different levels of DNR (in Paeds at least, I don’t know if it’s the same in adults). Some children only get rescue breaths and no ventilation, some get NIV and no ventilation. It varies case to case. All patients should be made comfortable, a good death is just as important.

What AnnaMagnani said - if you are not happy with the decisions being made about her care then focus on those decisions - is there something specific she's been denied that you think she should be having? Something palliative eg pain relief, or some social care? Has she had an Advance Care Plan or Anticipatory Care Plan put in place? This should have more detail about what treatment decisions have been made other than DNAR. Has she completed the Respect process www.respectprocess.org.uk (depends where she is).

LEM, I'm my mum's POA. I did the application for her - for finance and decisions regarding her health - via he HMRC website. It costs £41 for each application and it gets officially lodged once you've filled it in (online) paid for it - then printed it and got it witnessed and sent off.

My mum doesn't want to be 'kept going'. I'll do what she wants, she's very clear about it.

Hope it all works out for you to get this in place for you, in the format you want.

It's unusual in adult care to have different levels of DNR. However it is common to have an Advance Care Plan, particularly in a frail older adult for whom surgery is inappropriate - this may include medical things like not for surgery, not for ITU, but personal things like wants stay at home, favourite foods are x, wants to listen to x music.

As harsh as it sounds if a AAA ruptures it is usually fatal within minutes with no chance of CPR getting her back unfortunately.

Speak to PALS about her care though. They should not be treating any other ailment differently.

Sorry OP.

Having been in this situation, with a sister who wanted to keep elderly family members alive as long as possible because she couldn't bear to lose them, it's not always the kind thing to be very proactive with treatment. My family member was really upset that he was kept alive as his illnesses reduced his quality of life past the point where he wanted to live.

Perhaps your mum is not so keen on active treatment and the doctors have picked up on it. Not everyone wants to live with complex illnesses and reducing independence. Not making her comfortable and pain free with dignity is a different thing.

As PPs have said, CPR is no fun and with someone in your mum's situation is highly unlikely to be successful.

Sorry you are going through this OP.

Nurse here - DNAR should only apply to decision to give resus in the event of a cardiac arrest, and not effect other treatment decisions. However it's not uncommon for people receiving end of life care to not be given active treatment for certain conditions. This can be because the doctor's suspect it will have limited efficacy, or because the doctors think she is frail and giving treatment will be difficult / unpleasant for the patient to tolerate, and only serve ultimately to prolong suffering.

Although relatives are often involved in discussions about DNAR, it is ultimately a doctor's decision as to whether resuscitation is appropriate. In honesty, resuscitation is a pretty brutal procedure (usually involving breaking people's ribs etc) and in older people with chronic health issues it is usually of limited success anyway (and often 'successful' resuscitation means a person survives but with even greater health issues than before, and it's not uncommon for a further cardiac resuscitation to occur shortly after the 'successful' resuscitation and the patient passes away anyway).

I would personally caution against asking the DNAR to be removed, but I think it's fair to ask for a meeting with the doctor's to discuss their rationale for not giving treatment for her health concerns.

Is it a DNACPR form, or a ReSPECT form? ReSPECT forms reflect the discussion between clinicians and patients about the level of intervention they should receive in the event of an acute deterioration.

They are very flexible, and can range from a simple 'DNACPR' to 'DNACPR', for central inotropes (blood pressure support), not for intubation and ventilation, for BiPAP/CPAP, etc.

Ultimately, legally, any decision on treatment is for the Consultant to make. If a patient has capacity and specifically says they don't want resuscitation, then an attempt to resuscitate could be considered assault. But a patient can't make a Doctor carry out treatment they think is unethical (i.e. would cause suffering rather than benefiting the patient).

It is sometimes very hard for relatives to accept that a doctor is acting in the best interests of the patient by withholding (some) treatments. The doctors should be willing to talk it over again and again, until the relatives can understand their reasons, even if they don't ultimately agree.

@colditz nothing at all

Can I ask briefly what treatment it is you think your mother should be receiving OP?

Just a side note on the Power of Attorney issue. If she has dementia, she would need to doctor to say whether she still has capacity or not to allocate someone to be her Power or Attorney and communicate this to her solicitor. If she is not felt to have capacity to assign Power or Attorney, you can apply for Court of Protection instead, but it's an incredibly lengthy process.

CPR is brutal and rarely has a good outcome. It's the last thing I would wish on an elderly person.