To get DNR revoked

[TheoriginalLEM]

Thats it really.

How can i do this?

If your mum has complex health needs it may well be that the treatment for one will have an adverse impact on another and that a decision has to be made on where the balance lies. My FIL struggles with this as has a number of conditions that clash e.g. one benefits from exercise but another means he needs to rest, and the drugs for one make another worse. Make an appointment to discuss your concerns. It might be that she is getting the most appropriate treatment for her set of conditions and it just hasn't been explained clearly.

been on the cpr team. trust me its fucking brutal, not like telly where it nearly always works.

only works small % at best of times.

for someone with described history I`d leave it. Let her have some dignity.

Power of attorney can take up to 8 weeks to get. You don’t need it to make decisions in these circumstances- if your mum is deemed incapable of making decisions the medical people will look to you as her next of kin to do it for her.

So sorry you're dealing with this stressful situation
Like previous posters have said, a DNACPR is a clinical decision and, whilst patient wishes can be taken into account, it is ultimately up to the clinician. Patients have the right to refuse treatment but not demand it - therefore a DNACPR form can't be revoked unless a doctor agrees that CPR would be of benefit. There is no concept of 'signing' a DNACPR, they don't require patient consent and are only signed by the doctor(s) involved. Your mum may have previously expressed that she would prefer not to have certain interventions performed- could this be the case? If you feel as though decisions are not being made in her best interests, it may be worth speaking to the team, as they might be able to explain why certain things are/aren't happening. Otherwise, it is time to speak to PALS.

DNR should be exactly that

if treatment is being withheld, that needs investigating.

From my understanding OP was offered an admittance to a cottage hospital so mum's needs could be fully assessed but she refused and discharged her. IIRC it was following taking her mum to A&E and refusing to leave until an admission was made so she could be adequately assessed for care.

It's difficult when a parent is illl OP but I think you need to take a step back, breathe and write down exactly what you want to happen and feel would be in her best interest. Don't make any big decisions until you are clear on what this looks like.

Im not sure she really understood when she signed it tbh

DNARs are NOT signed by patients or relatives. It’s a clinical decision made by doctors, usually and preferably involving the patient and family. Where families are insistent that we do CPR in a hopeless case rather than argue we’ll do 2 rounds of CPR and then stop. The outcome is the same.

I think in the long run OP would have been happy to wait for the assessments and cottage hospital, had she felt her mum was getting the right care in hospital. There are reasons as to why medications are delayed, but going a few days without her Addisons meds is poor care and along with the other issues OP what might not have been the best decision long term, but the one she felt was right for her mum given the circumstances at that time. I agree that now OP needs to get her thoughts together and plan what she wants from services, and if she thinks it warranted report to pals for the prior issues. LEM sorry if I'm way off the mark there, just what I gleamed from your posts.

Agree with Prequelle. LEM, you need an evening off worrying. You've done great, now have some time for you

Stripping there were no beds. Otherwise i might have peruaded her

Ok so there is a back story to this.

I think you need to work out what you want to achieve.

Getting POA if your mum has capacity will take some time. If she doesn't then it will take a lot longer and be far most costly. Maybe this isn't achievable or even necessary at this stage so maybe decide whether giving your energy to that is best right now.

Has your DM giving permission for the doctors to discuss her treatment freely with you. I know my DM had to do this and be recorded in her notes. If she has then I would ask for a meeting with her care team and get those answers to your worries. If she hadn't given permission then it might be worth seeing if she will (assuming she can consent) as it will make things a lot easier moving forwards.

I don't know the back story but I wouldn't be too focused on the DNR. Also consider whether and what active treatment is the best as often it comes with other downsides.

Ok so there is a back story to this.

I think you need to work out what you want to achieve.

Getting POA if your mum has capacity will take some time. If she doesn't then it will take a lot longer and be far most costly. Maybe this isn't achievable or even necessary at this stage so maybe decide whether giving your energy to that is best right now.

Has your DM giving permission for the doctors to discuss her treatment freely with you. I know my DM had to do this and be recorded in her notes. If she has then I would ask for a meeting with her care team and get those answers to your worries. If she hadn't given permission then it might be worth seeing if she will (assuming she can consent) as it will make things a lot easier moving forwards.

I don't know the back story but I wouldn't be too focused on the DNR. Also consider whether and what active treatment is the best as often it comes with other downsides.

for you and your mum.

Sorry about the double post.

Not making your mum comfortable and not resuscitating her if she dies are two different things and should be treated as such by healthcare providers.

I have a good friend who is a nurse in a geriatric ward and it’s very sad to hear about patients on which CPR is administered when the patients should just be allowed to die - often at their family’s (distraught) request.

My Nan was brought back before she died a few weeks later and I remember how grey and worn out she looked afterwards and so I can completely understand the reasons why a DNR has been put in place.

You really need to speak to her and to the people in charge of her care. A health and welfare LPA can be made online via the gov.uk website but they usually take 12 weeks to be registered at the OPG and are not effective until they’re registered.

I don't know the backstory but clearly there is a long trail here

the hospital sagas can be horrendous. If you have been really stressed with it all, then stop for a bit before thinking about the DNR. It's really easy to go down the wrong road, especially when all kinds of different hospital staff are saying and doing contradictory things.

This is quite a personal post for me Lem but I hope you can appreciate why I’m sharing this.

My mum died of bowel cancer 6 weeks ago. She’d had a DNR in place for a couple of months prior to that and I thought I felt comfortable with that. I knew she was dying and she knew she was dying and was surprisingly at peace with that.

She was managing really well pain wise etc right up until the last few days when she suddenly had a bowel obstruction which then ruptured and essentially she bled out internally. I found myself really struggling to cope with the idea that actually there was nothing they could do except administer a morphine driver. I got quite angry and upset with the care staff at the hospice - which I am sorry for now- because I felt they needed to be giving her blood transfusions or “treating” her. When the reality was that they couldn’t really- it was like sticking a plaster over a dam.

Sometimes the kindest thing to do is not what we, as a child to our parents, want to hear.

I know you love your mum, that comes across from your posts, but they won’t have issued a DNR without good reason - a consultant needs to sign it and agree to it. Whilst they should still provide care and treatment I think you need to accept that maybe what you want for your mum now isn’t possible, it’s okay to let her slowly go. No one can say you haven’t done your best.

DNAR is ultimately a clinical decision.
Made by the medical team taking into account the thoughts and wishes of the patient and family but if it is felt it would be futile to attempt CPR due to life limiting conditions then it is inappropriate

It should however never dictate decisions other than DNAR. Ceilings of care should certainly be discussed as often patients have clear wishes regarding their priorities.

Your fears about your mums care should be discussed with her medical team ASAP but her thoughts on it are paramount and take president over anyone else’s.

I don't agree that DNARs just means doctors will not resuscitate in the event of cardiac arrest. That is what should happen but in my DF's case it did influence treatment decisions.

When I asked why my DF was not in antibiotics I was told by a doctor it was because there was a DNAR. I went ballistic.

My DF's blood pressure has fallen very low and I had to make them stop giving him BP medication too.

This was on top of asking me to sign a DNAR when my DF hadn't even had tests yet alone the results of them. I did make an official complaint and received an apology but they also informed me that the final decision is up to the doctor anyway.

OP, I can understand the DNAR coming into effect if the aneurysm ruptures. It would be unlikely she could be saved in those circumstances anyway. However, please complain to the CEO of the trust if other treatment is being withheld as that is totally unacceptable.

@collectingcpd

DNARs are NOT signed by patients or relatives."

When did this change. Back in 2010 I had to sign one in respect of my DF.

*Summersunsareglowing they have never been signed by patients or relatives.

I have been in practice since 1999 and it has always been the consultant's signature on them, with a space for documenting the discussion with the patient/relative but not their actual signature.

In that time I have seen many different versions of the form but the basic law and concept haven't changed, you don't sign your own form.

Unfortunately OP, you cannot simply get the DNAR revoked on your say so. However, if you have concerns about your mother's care I would advise you to talk to her healthcare team about them.

I think it is important to realise is that resuscitation is something that is a medical treatment and a patient/family cannot oblige doctors to attempt resuscitation if they feel it is unethical/futile or actively detrimental to the patient. Of course, in reality most doctors will want to work in conjunction with patient to help them understand the implications of both courses of action and will want to respect a patients wishes (which is the right thing). But at the end of the day it is a medical decision whether to attempt resuscitation and when to stop.

Resuscitation is not like you see on the TV. It very rarely works in frail people who have multiple serious co-morbdities, especially if cardiac arrest has occurred out of hospital. It is a brutal, invasive thing and should not be done in cases where it is highly unlikely to be successful. In these cases there is a low chance of success and an almost certainty that there will be some harm done. From experience, it's awful. In most frail elderly, if you are successful then there are usually complications and many will have a further cardiac arrest and pass away within a short period in any case. I'm sorry to be blunt, but it really is something I feel strongly about having seen too many very sick or frail people be put through a resuscitation attempt.

If your mum has capacity, it will be her decision in conjunction with her doctors. You can discuss your concerns with them but ultimately if she disagrees with you then your wishes will not supercede your mothers' decision.

If she doesn't have capacity AND you have power of attorney (welfare) you can discuss it with her doctors and they should work with you to make a final decision.

If she does not have capacity and you haven't got power of attorney, her doctors may well discuss matters with you but you won't necessarily have the final say. In my experience, someone who lacks capacity due to cognitive impairment and who also has several co-morbidites- one of which is a significant AAA- is highly unlikely to be a good resuscitation candidate. Any attempt would be futile and may actually lead to a very undignified death, as opposed to being made comfortable and having a peaceful passing.

I'm sorry if that seems harsh. I think you need to be very clear as to the reasons behind the DNACPR decision (and whether the decision is made by your mother) before trying to have it over-turned.

As been previously stated, the DNR simply means do not resuscitate if the person in questions heart stops beating- it does not mean do not treat

I don't think the conversation you should be having is whether the DNR is in place or not, but rather whether you think the health care team is doing everything they can for your mum, if not, why not?

Removing the DNR will not make a difference to treatment, in theory. I'd have a conversation with the Doctor in charge of your mums treatment and ask about treatment/why they are doing what they are(n't)/what else can they do

Sorry this is a difficult time for you OP

Does your mum have capacity? If yes then it is her decision. If no then unless you have LPA for health and welfare it would be very difficult for you to challenge this.
The doctor who issues the DNAR can be challenged however this will be through a solicitor appeal to court of protection and for the most part someone at that age with complex medical needs the decision by the doctor would stand.
If you are convinced decisions are not being made in her best interests I would seek input from an advocate or IMCA if she lacks capacity.
Also if she does lack capacity all decisions regarding treatment or nontreatment should be made via best interests meetings including professionals involved, family and advocacy.

Also as others have said DNAR is purely around decision not to do CPR in the case of cardiac arrest. It does not pertain to treatment, that is usually outlined in an advanced directive.

LEM, if the issue is a lack of care then your efforts would be better spent addressing this with her clinical team or speaking to PALS rather than changing the DNR (which may have unpleasant consequences for your mum)

I understand that the two things seem related but they really shouldn't Be, and if you feel that the DNR is influencing her care this should be raised directly with the hospital, otherwise you could easily end up in a situation where the lack of care persists even if the DNR is revoked.