To ask your opinion in DNR?

[susandelgado]

My mil, a wonderful lady of 85, is in hospital for what seems to be the last time. They can't treat her many conditions any longer 😐 She was approached this morning by a registrar, who said he had spoken to her family and they wanted to put a DNR on her notes. He explained to her what it meant and she agreed, as she's had enough of it all and doesn't want to fight any more.
The thing is, this has NOT been discussed with her children, and they were very upset when they found out. They fully agree that it's her choice, but not the underhanded way in which it was done.
It makes me very angry, and seems almost negligent on the hospital's part, why the hell couldn't they have told the family first? They have power of attorney for medical matters.
Has this happened to anyone else?

Does you MIL have mental capacity? The way you’ve worded it suggests she does and that she agreed to it.

It’s actually not the family’s decision to make.

It’s the medical teams decision, usually in collaboration with the patient. They will often involve family if they’re present but more in an informative way than as an agreement.

Nothing underhand about it at all.

Firstly, I’m sorry your MIL is so poorly. What a difficult time. Does your MIL have the capacity to make decisions? If she does, then it’s right she is approached before her family but it was totally unacceptable if she was told it was discussed with her family when it wasn’t.

To clarify, the LPA is only relevant if she’s lost capacity.

Sorry misread your post.

The doc said they’d spoken to the family but hadn’t? Is she sure? If they have POA does she have capacity?

If they had told the children first, its likely they would have tried to talk her out of it. This is her decision to make, and theirs to accept.

As much as anything to prevent a distraught family piling the guilt on granny for her agreeing to 'check out' when her time comes, no heroics?

No idea why they would speak to the family first tbh, why do you think they should make the desicion over the patient? Or even be informed this conversation was to take place?

I’m more inclined to think there has been a communication error rather than deliberate attempt to deceive.

If they told her they had spoken to the family when they hadn't, that's underhanded. Unless there are other family members they are referring to?

It is underhand to say you’ve discussed it with family when you haven’t.

I agree with @Sidge. Resuscitation is a violent intervention- not as seen on tv - and would be unlikely to have a beneficial outcome for an elderly, unwell patient. My DF was DNR when he had pneumonia. I wouldn’t have had it any other way.

Sorry just seen this who said he had spoken to her family and they wanted to put a DNR on her notes. - if that is true, then that is definitely not ok!

It is a medical decision so doesn't matter that family have power of attorney.

However it was wrong to suggest family have been spoken to if they haven't. But it would be more a case of informing family and explaining reasons rather than asking for their agreement so I don't think it is negligent.

Does your MIL have capacity to make the decision for herself? If so it's her decision to make: POA for health only comes into play if someone no longer has capacity. If your MIL chose to have the conversation on her own with the doctor then that's her choice.

In addition, the dnar is because 'CPR would be inappropriate, unsuccessful or not in the patient's best interests': it does sound as if it's appropriate for your MIL.

HOWEVER

If the doctor said it had been discussed with the family but this was not true and it had not been discussed with the family then that is grounds for complaint. Speak to the ward staff but also the hospital PALS team (there will be posters on the wall). That really is terrible.

Of course POA would only kick in if she didn't have capacity

This happened to dh elderly mum a few years back. She had alzeimers and was in hospital for a chest infection. Through the might her sats had dropped and she was approached my a doctor that said they wanted to put a dnr into her notes if she lost consciousness. She agreed but who is to say she understood???!! The hospital at this point also weren't aware she had alzeimers.
When my husband was visiting he looked in her notes and discovered what had happened through the night and that a dnr was inside. He immediately asked to speak to the doctor and they confessed that had no idea she had alzeimers.
The dnr was removed.

It’s actually not the family’s decision to make.

@Sidge
My Mum is dead now but a few years ago when she was rushed very poorly in to hospital my sister, who was the only one present at the time, was asked by the doctor whether to put DNR on her notes. Mum would have been too poorly at the time to be asked.

Nothing underhand about it at all
If they told her they had discussed with her family when they hadn't that sounds underhand. What if the lady agreed to it herself because she thought that was what her family wanted.

It is really hard to hear that the medical staff can do little more for your loved one, but I don’t think they suggest DNRs lightly. If she has competency to make her own decisions, I don’t think they have been underhand. It should be her decision. If she has made peace with dying and would prefer to go peacefully, rather than them attempt to resuscitate her (which probably wouldn’t be successful), which would mean her last moments were being poked, prodded and hurt even further. I’d actually be glad she took the decision out of my hands and made it herself.

I’m really sorry you are going through this though. It is an awful place to be in, when you are told nothing more can be done for your much loved relative.

Sorry you are in this situation. Does mil have any form of dementia or memory problems? How is her day to day life normally? Does she have carer's etc.

I can understand this being a shock to you all, but this process isn't done without taking everything into account. A DNAR (do not attempt resuscitation) doesn't mean necessarily they won't treat her, give fluids or antibiotics etc. It means if her heart (cardiac arrest) were to stop, they wouldn't start cpr. Only 8% of cardiac arrest patients survive, its very hard on the body. Feel free to talk to the nursing staff or doctor on the ward and get them to explain. They can and do take the DNAR status off a patient if they become well again.

I think families need to talk about this stuff more. Myself and my parents are all aware of each other's wishes - I know my mum is an organ donor and also wants no heroic measures. If she was on life support with no chance of recovery, she doesn't want to stay alive. We discussed stuff like this from quite young - i rode horses and it's come up in conversation
Mum was diagnosed with dementia age 65 and I have spoken to my dad regarding a DNR, for instance if she gets pneumonia and stops breathing, why resuscitate her to live for another 5 years of hell?

I would be cautious about assuming there was a deliberate attempt to mislead by saying that the family had been spoken to. My dad is fully compos mentis, not even very old and he got the result of a blood test completely mixed up recently. I wonder whether your MIL was told that her family would be spoken to rather than that they had been?

It's ultimately up to the consultant doctor who is looking after her.

Sorry to be so blunt but I wouldn't fancy breaking the ribs of an 85 year old lady with lots of comorbidities, better to let her have some peace and dignity.

Saying that they shouldn't have said they've talked to her family if they haven't, that's strange.