There should be full information about what resuscitation actually entails.

[OverUnderSidewaysDown]

There have been a lot of press stories about older people being “forced” to sign DNR forms and understandably their families are getting upset.
However I think a lot of people believe that resuscitation is like it is on TV - pads being affixed to the chest, stand back everyone, patient miraculously recovers. It isn’t. It’s a brutal process that can result in smashed ribs, and for frail elderly people it can leave them in a much worse state, either dead or with prolonged suffering.
This should be made public knowledge, no dodging around the facts.
AIBU?

Luckily during end stage cancer my mum was in and out of lucidity so the DNR decision was made by the Consultants and in agreement with the family. It had got so bad that for her to be brought back from the brink to only prolong suffering whilst waiting for the inevitable would have been criminal in my view.

It’s a horrible decision to make but it’s also a blessing in some twisted way and is never taken lightly. Sometimes I think dying is the body’s way of saving itself if that makes sense?

YANBU. What people are not realising is that they are being asked this because if they contract Covid and reach that point, resus is going to be futile and will do nothing but make their last moments painful, undignified and traumatic for everyone present. As PP said, I think some people also conflate it with "no treatment whatsoever" which is not the case - people will absolutely be treated up to that point.

It should still be the individual's decision though, not something imposed on them.
I get why you would think this, but no, this is not and should not be the case. You can decline any proposed treatment, but you cannot demand that a doctor gives you a treatment or intervention that in their judgement would do more harm than good. A doctor ultimately makes the decision, because medically and ethically, if a medical team concludes that resus is futile, it would be wrong for them to do harm by administering it.

The bottom line is really that as a society we are far too detached from death. We think it can be put off forever or at least until we are 102 and quietly pass away in our sleep - and from a diet of TV shows, we think resus leads to the person coughing and then waking up, fully recovered. Sometimes death is inevitable and the absolute best thing that can be done for a person is to facilitate that death in a calm way. Doctors know the harsh reality and they don't have bandwidth right now to coddle our delusions of immortality.

I think we need to come to terms with the fact that 80s / 90s is a bloody good age to get to and it's ok to let people go when their time comes without trying to force life into them that may not be good quality of life.

X2boys my gran was on the Liverpool care pathway. They told us she would die quickly and peacefully. Several days later she was sat up in bed asking for a cup of tea. I had to kick up a massive fuss for them to take her off it because it was a Sunday and inconvenient apparently. They'd rather starve her to death then do their job properly.
Should have complained but was just glad to get her out if there.
Still alive 7 years later.

@Blacksideupanddownagain If you google - NHS 'what happens if my heart stops' it will link you to pdfs of various hospital trusts info leaflets about resus and how the decisions are made.

Agree 100%. An elderly neighbour of ours was resuscitated after a heart attack, not his first. Some weeks later he told me that the after-effects were so painful, he wished they’d just let him die. He did in any case die a few months later.

Having heard that, I was later insistent on no such treatment for my elderly mother, who had dementia and was unable to speak with mental capacity for herself. I made sure it was on her record, but thank goodness the situation never arose.

I think there needs to be full and frank discussions with members of the public

You're right of course, but that's not always easy. When well, folk don't engage because they believe it'll never apply to them, and once a much loved family member's sick the conversation can become much more difficult

As we see on here all the time, even the gentlest suggestion's immediately assumed to be an attempt to "just not bother" about them and "let them die"

Whatwouldyoudo I agree, 80s/90s is a bloody good innings for anyone.

My mum was resucitated and had an awful final two years of life, it would have been best for all concerned if they'd just let her go. She agreed.

I also heard a Dr explain that CPR is to try and revive someone who had already died. It is not stopping death, death has already occurred and it's trying to reverse that.

I think we need to come to terms with the fact that 80s / 90s is a bloody good age to get to and it's ok to let people go when their time comes without trying to force life into them that may not be good quality of life

Yes, and this ^^

Some of us have been saying similar for years, and awful as the current situation is, it might just have some use if it encourages a conversation around the whole issue

YANBU

I agree with all of the above. There is also the risk that be resuscitated but remain in a vegetative state for days, weeks months....

Nightmare.

absolutley agree with OP.

I think this issue has got confused because of the news that elderly people in care homes are not going to be admitted to hospital if they get CV19. IMO no-one has the nerve to say that it is a sensible decision to take if resources have to be rationed. It's not going to be true in every case, but on the whole, an elderly person who is in a care home, ie already probably has other medical issues, is probably not going to survive intensive hospital treatment but would be using resources that could save someone who has a better chance of survival.

What many people do not seem to understand is that DNR might be a persons choice, but actually it is a medical choice to be made in the best interest of the patient. It can be made without the patient or family consulted but is usually made in discussion with the family so thatt they understand if it would be futile/cruel to attempt resuscitation rather than a gentle death. This is where misunderstandings can take place. Many doctors are skilled in this. It is also up to families to understand what is being said to them which can be very difficult when you a in an emotional state. It is always good to repeat back to a doctor or nurse what you have understood to be sure you have got it right. For many older people resuscitation is the worst thing you can do. It is human nature to want "everything that can be done" If you watch the Corona briefings and then listen to the journalists questions you can clearly see how people get the wrong end of the stick or have misinterpreted the message,

Slightly off topic but does anyone know what happens with CV?
I’m not scared of dying just worried if I get CV and there’s no hope I would be left to drown over a couple of days rather than being given an injection to end it all.

I've been resuscitated (twice), including full CPR. I am obviously statistically very, very lucky. It's not just the physical impact of it, but the emotional side too. I would want to go through it again due to my personal circumstances at the moment, but I can see when I am in my 70s or 80s I may not make the same decision.

It should be the individual's choice, although doctors have always had the option to not resuscitate too - they rarely go against a person's wishes if they are known. No one should be "forced" to agree to a DNR.

Thank you for these helpful replies. Hopefully fuller details will find their way into the press once they get over this phase of interviewing upset relatives. Don’t get me wrong, I totally understand why these relatives are upset when their elderly relatives are presented with the form to sign. It’s hard. But they need to be fully in the picture about the resuscitation process.

@cupoftea84
The liverpool care pathway is another discussion altogether and is not DNR. As another poster put it, the patient has technically died when the heart stops. This is not the same as withdrawing nutrition

I would never agree to be resuscitated when elderly, I've been a nurse too long. I know what happens.

@Fairyliz
No you cant be given an injection to end it all, that is only legal in veterinary

It’s hard to change some people’s perceptions, though.

After many years’ contact with relatives of people with dementia, I’ve heard many times of relatives being so angry/indignant if everything humanly possible was not done to keep the person going, no matter how pitiful the state they were in. Not just resus, but e.g. feeding by a surgically inserted tube, never mind badgering and pestering someone to eat and drink when they so clearly no longer wanted to (I have witnessed this.)
I’ve known people say, ‘I’m not ready to let him/her go!’ - never mind if it would clearly be so much kinder to let nature take its course.
In some cases I think ‘striving to keep alive’ can verge on cruelty.

Fairyliz- with CV as with other terminal illnesses, we give you medications aimed to ease distress, stop the feeling of breathlessness, reduce respiratory symptoms and ease pain. Unlike usually with drugs where there is a max limit, we can increase these far beyond these limits to the point at which the patient is comfortable. We can do this in a palliative setting, accepting that this increased dosing may hasten death.

The no visitors ban goes against everything that we train for and so we are facilitating telephone/video calls with families, writing letters that patients dictate to us, getting handprints and locks of hair. And most of all, while we know we are a poor substitute for family,we are sitting with patients so that they are not alone.

For anyone who is having a will drawn up you can also drwa up power of attorney forms both for finance and health and social care. In this there is an option for your attorneys to work with the doctors to make te best choice for you, or you can actually specify your wishes in certain circumstances.

YADNBU.
CPR can sometimes be effective in situations where the heart and/or breathing has suddenly stopped, e.g. heart attack, major blood loss, electric shock. It's used to 'buy time' in the hope that the underlying condition can be corrected

This is different from death as the end stage of a disease process.

YANBU at all.

Resuscitation is often the worst option.

EndothermicHands thank you for your incredibly compassionate and helpful post. And for everything you and your colleagues are doing.