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?

From what I've heard from doctors, a resuscitation is a really horrendous thing to experience. If it's not likely to be successful, it is more humane not to do it.

I'm sorry to hear that you're going through this. It must be very hard x

@susandelgado if MIL is absolutely sure that's how the conversation with the registrar went then it's absolutely grounds for a complaint. It's totally unethical.

If what MIL says is correct, then they have lied to her and fabricated a conversation where her family supposedly pushed for a DNR note, presumably in order to coerce her into agreeing to the DNR that they want. They know that elderly and infirm people are particularly concerned about being a burden to their families.

@Herringbone31
Your post has nothing to do with anything. This discussion is nothing to do with mistakes
@bridgetreilly
Your post would not make any sense to medical staff.
There is a lot about the original post that suggests a lot of misunderstanding about resuscitation.
@SeamstressfromTreacleMineRoad
And this is exactly what I am talking about, I also watched a futile resuscitation on a frail old lady that broke all her ribs, achieved nothing and was an immoral assault on a body.

I can't believe how many people are just totally missing the point of this thread. OP's family are supportive of MIL's decision - as long as it is her decision. There does not seem to be any confusion or lack of understanding surrounding the realities of resuscitation of an 85 year old woman. OP is not questioning why the family were not asked first.

This is purely about an elderly and vulnerable woman being (allegedly) lied to and potentially coerced into agreeing to a DNR.

Before people start accusing and.reporting doctors and nurses they might be better off talking to them first to actually find out what took place. Patients do get muddled up if there is a lot of information.

An 85 year old with multiple severe health conditions is not going to survive a resuscitation attempt, it rarely works on the young! We’ve got to start accepting as a society that we will eventually succumb to old age and death!

It's more than likely she consented to it and maybe one other family member, who she is closest too, who is keeping very quiet about that fact now.

It's her choice so just leave it at that.

This is probably exactly what she didnt want, family members like yourself making an even bigger annoying fuss about her choice.
Leave the poor woman alone

They shouldn't have said family had been consulted when they hadn't, that's inexcusable.

Otherwise, YABVVU. She has capacity, so the hospital would be grossly in the wrong to have discussed with her family first. That's an utterly outrageous suggestion: do you think people stop being entitled to confidentiality when they're old?

She should complain about being given false information though.

The OP specifically asks why the family weren't told first bringbacklangcleg.

It's possibly they thought they'd spoken to the family and the family hadn't realised what they were talking about. For example, a medic spoke to me about my father's wishes, would he want to go into hospital if he was ill, etc. He mentioned asking himself the question "would I be surprised if your father died in the next 12 months". I now recognise that as being a question to ask when considering whether top put someone on the "gold standards palliative care framework" but I didn't recognise that at the time, and thought it was a general statement, I had no idea that was what was being considered. But I'm sure the medic felt he had discussed it with me, and that he had tried to do it in a sensitive manner.

@NoMorePoliticsPlease. The OP said the family had been informed. That wasn’t correct according to the OP. I’m saying mistakes can and often happen.

@BoxedWine yes in the context of them having POA, not because she is saying that families should routinely be forewarned/asked permission for a DNR which is what a great deal of posters are talking about.

Poa makes no difference in health decisions. If a patient has capaxity they make there own choice. If a patient lacks capacity a best interest decision is taken. Poa does not give anyone the right to demand or refuse treatment for someone who lacks capacity. It is a medical decision based on all the facts. If there is conflict sadly sometimes the courts get involved and make the final decision.

But you said OP isn't questioning why the family weren't asked first bringbacklangcleg when that's the precise thing she's doing.

Speaking as someone who unfortunately has had to regularly perform CPR on elderly patients... I had a frank conversation with my own grandparents maybe.. 2 years ago (early 80s and up until very recently have been in very good health) and emphasised that the best course of action is a DNAR.

It is a truly horrific act to perform on anyone, let alone someone elderly, and it has a minimal success rate in someone young let alone the older generation.

It is a highly undignified way to die, and I wouldn't wish it on anyone.
At the end of the day... it is down to the medical team, and if they feel it is futile to attempt then they are unlikely to attempt it, DNAR or not, or it may lead to a short attempt and a full discussion of whether continuing is ideal or not.

It is brutal and an awful way to go, with no respect for the patient really. It is nothing like on TV - not a case of a few compressions, shock and hey presto their heart is beating.
In 4 years, I have shocked using a defibrillator once, all others have not been shockable rhythms.

I misread your original post, and if the dr did say that then I understand your frustration, but perhaps he was mistaken or she misheard him.

And as for power of attorney, that only comes into play once she loses capacity to make her own decisions, or if she chooses to give the decision to the powers to decide for her, albeit she has final say.

It is a difficult subject to discuss, think about, and has a ringing sense of finality around it, but there are very few people I would choose to perform CPR on if I could choose for myself. Simply because the outcome is not favourable for the patient, or indeed if their heart does stop beating then there is the possibility of brain damage and a very poor quality of life.

It is a medical decision, it should be discussed with family but family do not have to consent for a DNACPR to be implemented. Additionally, a DNACPR could be implemented at the time of arrest (not great practice but possible). I think when people are told their relative needs a DNACPR they become defensive and very young want to leave my mum to die!’ But that’s not the case. Resuscitation is brutal- CPR breaks ribs, being tubed to breathe isn’t nice and the outcome of walking out of hospital is low. Plus, there are people with many conditions (such as COPD) who would not come off the ventilator if they were sent to the ICU. So a DNACPR should be followed be a TEP (treatment escalation plan), this could say all treatment will be given, including some ICU level interventions but just not CPR or it could say just for ward based care.

I am pro-DNACPR because resuscitation is brutal with a relatively low success rate. Better to leave an elderly/person with other co-morbidities to be dignified

Thank you all for your answers. I totally agree that resuscitation is the wrong thing for someone frail her age. I just hated the thought that the doctor had lied to her about the family being consulted and her reaction to that. She's a wonderful person and mother and doesn't need that kind of stress at this time in her life 😔
It's up to her children now if they take any further action.

@HappyHammy

Not strictly true, there can be a power of attorney appointed for either financial or health decisions (or both).

You're correct in saying a LPoA for healthcare couldn't compel a medical team to provide any treatment (including CPR) if the team felt it wasn't appropriate, but they could have direct decision making for decisions in treatment choices for example a choice between surgery or not for cancer, bypass or stent for angina, fixation or just a plaster for a broken bone.

My 82yo FIL has capacity etc but when doctors talk to him he gets totally confused and is often convinced they have said the complete opposite of what they have said. Eg "you have a UTI and I will prescribe antibiotics but because if your other issues I will talk to your consultant tomorrow. He may want a scan" became "you need a scan tomorrow" in his head and many similar because he panics. Could that be what happened?

I would ask to speak to the doctor who told her this and ask why.

When my Dad was admitted to hospital recently I had a detailed conversation with the doctor and my mother regarding resuscitation. Dad has dementia and therefore does not have capacity.

I was really quite pleasantly surprised about how it was broached and the different layers of discussion. For example we would wish for him to have antibiotics for an infection but not admission to a higher level ward for more intensive therapy. We would wish him to be treated for an incidental injury but only to a level to reduce pain and suffering, not complex surgery because he wouldn’t do well with the recovery.

We were able to make a plan we all agreed was reasonable and far from a black and white DNR although he definitely would not be actively resuscitated in the event of a cardiac arrest.

The doctor should be accountable for the comment about the family being consulted.

Is the registrar dealing with lots of women of about the same age? Could he/she have got the families mixed up? You'd have to be such a nasty person to tell someone that her family wanted a DNR if you didn't think you'd spoken to them.

@MatildaTheCat
That sounds much more sensible than our experience. Family will be talking to the registrar tomorrow to try and get some answers.

@DNR , it's a ward with lots of dementia patients so it's possible that's what happened. I hope we get some answers soon.

It would be extremely odd to lie to the patient about this. It is far far more likely there has been a misunderstanding. For example, what has actually been said may have been a discussions around whether your MIL had ever talked about this with family, or what her family would be likely to think about this.

Report to PALS if you wish. Alternatively, ask to speak to the medical team to clarify this further.

It remains, of course, a medical decision whether or not CPR is offered and it remains frankly unethical to offer futile treatment.