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.
That all sounds great, for someone for whom resuscitation is the only alternative and resuscitation wouldn't be appropriate. But the lines seem to be being blurred at the moment between the concept of a DNR and the idea of no hospital treatment at all. What about a patient with a DNR who might benefit from oxygen treatment? Will that be offered?
I think what's scaring some people at the moment is the idea that past a certain age or with a certain degree of existing illness you won't get any treatment, even if treatment well short of ventilation or resuscitation could actually help you.
DNRs are supposed to be discussed with individuals and, if they're not, sending out letters that are basically bulk mailings to particular demographics emotionally blackmailing them into agreeing that they shouldn't even have an ambulance sent for them is not the way to get them.
Talking to individuals who shouldn't have DNRs about how resources need to be saved for younger people is mixing up two completely different issues - what's best for the patient, and rationing.
I'm seeing a lot of justification of rationing of care on the basis that elderly people are less likely to benefit from being on ventilators. But DNRs don't exist as a way of rationing resources - that's something completely different.
If care is being rationed (which it's sadly going to have to be), that is fundamentally a frightening thing that people are perfectly justified being frightened of. Repeatedly explaining the concept and value of DNRs doesn't help with that. Sending letters mixing up DNRs and the idea of rationing, doesn't help. Sending letters to whole demographic groups some of whom might benefit from a DNR and some of whom won't, and mentioning how resources should be saved for younger people, doesn't help.
People should understand about resuscitation and DNRs, but concerns about the way care might be crudely rationed by demographic group are real and valid, and won't be helped by more and more explanations about DNRs.