To get DNR revoked

[TheoriginalLEM]

Thats it really.

How can i do this?

i dont have POA and i need it so i think we need a solicitor ?

You should see a solicitor for advice. It is quite a common misconception that once a power of attorney is needed that you can just call a solicitor and get the paperwork done. It's really not that simple if the person in question has cognitive impairment.

If your mum lacks capacity she may not be deemed fit to instruct a solicitor to get a POA put in place. She would have to be assessed to see if she retained enough capacity to name you as power of attorney.

In the event she is able to instruct a solicitor to create a power of attorney, it is not legal until it is registered with the office of the public guardian. But it is not activated until your mum is deemed to lack capacity to make decisions for herself (i.e. the power of attorney is activated- this is not at the attorney's discretion so not based on your say so). It is often quite tricky to get a POA done and then activated within days/hours- if they had capacity to understand the legal implications of making someone welfare and/or financial attorney, then they probably have capacity to make decisions about medical treatment or where they live. There are some cases, obviously, but not always.

If your mum is not deemed to have sufficient capacity to instruct a solicitor to create a POA, then she will need guardianship to be put in place. This is more complex and social work are usually involved with the court of protection making the final decision. In my experience, this can take some time to get in place.

Hi, sorry if I'm repeating what has already been said.
There are two issues here:

1. Has your DM given permission for you to speak on her behalf?
2. As you've already said yourself, you urgently need to speak to your DM about the DNR. Does she remember signing it / giving permission for it firstly? Is it what she wants? It may well be a hard conversation for you to have, and for that I'm sorry. I've been in the situation twice with my parents - when DF knew he was going to die, he made it quite clear what he wanted - no resuscitation, and to be without pain or suffering as much as possible. With DM more recently, she was very seriously ill and I was informed by staff that she wanted a DNR in place. I have no doubt that that is what she would want if on the brink of death, but what worries me is that she does not remember or at all. Sorry to waffle on, but I thought it might be helpful to you to know.

Sorry, to clarify, the speaking on her behalf is in respect to discussing her case with medical staff.

You do not need a solicitor to create a POA - you can do it yourself online.

However your mum will need capacity to understand what a POA is, and you will need to find a person, called a certificate provider, who can confirm that your mum has the capacity to grant the POA.

If she doesn't have capacity, then the time to get a POA has gone.

I would think long and hard before you do this. Many people don’t realise this, but DNR just prolongs the suffering and most of the time the person goes on to die anyway, esp someone at old age and w health issues. We didn’t realise about DNR last year, when my dad was in hospital and suddenly heart stopped they brought him back after 5 mins and we realised how awful and it was just prolonging his suffering. He ended up dying a week later, and suffering longer! Awful. If we signed the DNR he would have had a quick swift death. Instead we had to make the decision to unplug ventilator and let him pass away slowly. It took about 2 hours. I think a quick swift death is much more kind! Basically like a quick switching being turned off. Instead of being brought back to life only for more suffering in hospital and then watching in last two hours as he gasped for breath - AWFUL!!!

Anna

It is true you don't need a solicitor, but I think in this case it would be helpful given that there is clearly some question of capacity. They could guide OP better than the online forms.

ANNAMAGNANI you make a really good point there. Yesterday and on many days she didn't have capacity. Today i would say she does. I am concerned that you are right though. I sort of stuck my head in the sand as i always assumed POA was financial and i never felt comfortable with that as the last thing im interested in is my mums money. Not that she has much and is in social housing so mo house etc. I think that is a bit of a fail on my part.

I think pp who said i need clarification from the clinicians are right. It just feels like ive been told - yeah your mum has an aneurysm and ulcer but we aren't going to treat it. There was constant referral to the dnr and i was in too much shock to question it. Because no treatment on offer DP doesn't get the seriousness of it. Because i haven't had proper explanations im not sure how much of a time bomb she is sitting on.

Thanks - I think it would really really help you to know how big a time bomb this is.

Possibly they don't know but they might be able to give you an educated guess and I think you might make different decisions if you knew if you were talking lots of months, short months, weeks or what.

For example - does it matter what she eats? Should you just be letting her have whatever she fancies and not pushing her or worrying about her diabetes, or should you be trying to help her eat as much as possible but sticking strictly to no sugar? All these things are really important going forwards. And there will be loads of questions like this.

Not diabetic but yes those are the sort of questions i need answering. "Variable" is not an answer.

As PP's have said a DNR is only for the moment the heart or breathing actually stops. You really don't want to put your mum through a traumatic resuscitation, that she will not survive. It should have no impact on the care that she is receiving now. You need to talk to medical staff about it.

I'm not trying to be unpleasant, but what would you like them to do about her ulcer and aneurysm? The only treatment for both is major surgery which it sounds like your Mum wouldn't survive. There isn't anything else. I would suggest from what I've read that she needs a proper palliative care approach to both her diabetes and her general care. Has a palliative care team seen her? they don't just do cancer now and are excellent for end of life care for dementia and other issues.

I came across this recently and in my case, there were two options, the obvious DNR, if resus is needed, and do not treat if life preservering treatment is needed. The patient made this choice directly, I can’t speak for your situ this is just how I found the situation.

I think you need to discuss her care needs with her provider. DNR does not and should never mean do not treat.

I wonder if you have something similar to what we have here, which is called Goals of Care. Every patient is to have GOC discussed when they enter hospital, if it hasn't been done already. There are seven levels:

R (Resuscitative care) 1 is everything.
R2 is everything except chest compressions.
R3 is no chest compressions and no intubation.

M (Medical care) 1 is DNR, no ICU, but may transport to hospital and may do surgery, also treat active medical conditions
M2 is similar to M1 except it is surgery and transport only for symptom management

C (Comfort care) 1 is treatment of symptoms only, do not treat active medical problems, transport or surgery only for symptom management.
C2 is symptom management only, transport and surgery are not done. (C2 is for people expected to die within days.)

At discharge, the patient is given the original GOC document; a photocopy is kept in the chart. We tell patients to keep it on their fridge as EMS will look for it there if they are called. They are to bring it to hospital if they are admitted.

Based on what you describe, an M1 or M2 might be appropriate for your mum, but you'll need to have that discussion with her provider.

Oops sorry, I thought I'd remembered from your other thread that she was. Apologies.

This was why I said she needed a palliative care review in hospital as it's the sort of thing they do.

I think a big chat with her GP would be in order.

When mil discussed her death we filled in a very comprehensive form that the doctor gave us, it covered not only cpr but pain relief, fluids, drugs to be made comfortable, or drugs to actually treat. Did she want minor things treated such as skin rashes or sore throats. It was extremely detailed and we definitely signed it

The last time we called an ambulance for her she refused to go to hospital but the paramedics wouldn't leave until they had confirmation from the Dr that she had all this in place.

When the Dr came out a few hours later she was very direct and said MiI you do realise that if you don't go to hospital you will die and we can only make you comfortable now.

It's hard to deal with but it has to be done and if that's what the person wants then I think you have to respect that. At no point was treatment withheld from mil and she was able to change her mind right until the last minute. She died just a few hours later.

We had POA from long before it was needed. We didn't have any involvement in mil finances except to make sure bills were paid and anything she needed was bought, and that was only after she felt unable to do those things herself.

When we signed the DNR it didn't feel real. It was on a visit by a geriatrician and i was so gobsmacked it was even mentioned but i was of the view that DNR would just mean no heroic chest compressions etc. It felt light she had a good few years ahead of her.

But now this happened and i cant get my head around it. Today she was fine, her only discomfort was in her foot where she kicked the nurse in hospital!! She made jelly and came round for dinner. I can't get my head around that she has something so drastic going on. Im also concerned that i could have prevented this as she has issues with the drs and always refused to go to appointments etc. In the end i gave up.pleading with her to go. I should have been firmer but my mother is a law unto.herself

LEM, you need to ask them

1. what could be done, in theory, for the aneurysm and the ulcer?

2. in practice, can this be done for your mother, with her specific health conditions and age?

this doesn't sound at all connected to the DNR.

re food, tbh at her age I'd be eating whatever the hell I wanted. When my dad had second heart attack, he said "I wish I'd eaten more ice cream". I'm just really glad I got him to eat some good chocolate before he died - he was clinging to the view that certain brands were best and not full of palm oil, bless him.

My father went to A&E with heart problems, had a DNR in his hospital file but not in A&E. He was dead for 10 mins. They broke 4 ribs and punctured his lung trying to resuscitate him for him to die 4 weeks later anyway.

lalafafa

sorry to hear that.

my mum carries her DNR in her handbag. Whether or not that would help in the event, I don't know, but she's very adamant about it.

My dad died in January from renal failure. My mum & brother spoke to the doctor & agreed that a DNR was the best thing. The only thing that annoyed me was that they spoke to my dad without any of us being there, we were there at least 10 hours a day, yet they told him he was dying when there was none of us to support or comfort him, the same thing happened with my Grandad & I feel that someone should have been there from the family when they told them.

If she only sometimes has capacity it’s too late for you to do the POA yourself.

I would suggest, if your mum wants to, that you request to meet with her and her clinicians to talk it through and be clear about your expectations for treatment. If you're happy with their respons, great. If you're not, your mum can change her mind at any time and ask for it to be revoked. The doctors are not obligated to do so but usually will if it's a direct request from a patient.

As I think you already know, a DNACPR should mean only that if her heart were to stop - so she has in effect died, nobody would try to restart it. From the small amount of detail you've given it sounds like CPR would be futile but I'm fairly sure you know this and it's not the issue.
In theory a DNACPR should have no bearing in any other treatment decisions. If you feel it is, it needs discussion as above. However, as a PP said, the same factors may be influencing the DNACPR decision and treatment decisions

@AnnaMagnani
I definitely signed something when a Consultant discussed a DNAR with me in respect of my DF in August 2010.

I'll check later in case I have a copy of it as I obtained a copy of my DF's medical records when I made an official complaint about his treatment and care (or lack thereof).

I had this with my mum earlier in the year. She had pneumonia and septicaemia and, honestly, I didn't think she'd make it. She had family with her all the time, but at a time when she was alone, she agreed to a dnr, when the consultant was doing his rounds. The whole family were upset, because she was delirious at the time, in no fit state to think clearly.

When she felt a bit stronger, we spoke to her about it, and decided to respect her decision, as she was in a better place to discuss it properly.

Anyway, her gp called us in and she wanted to through all of it and she signed an official form there and then, confirming her dnr. So I'd start with a visit to your gp who will go through it all. Ours really took her time and explained it. It would be fine to revoke it, if she so wishes.

I work with lots of different hospitals and have never seen it used to restrict treatment. What will guide treatment is what the likely outcome of any treatment is. All treatments carry increased risks with age and worsening health, it's normal to switch from a mindset of trying to cure a condition, to one of symptom control to give them the best quality of life in the period before they die.