As an ITU nurse I have seen so many cases in ITU when continuation of treatment really is futile yet the doctors still want to carry on. And because families are not medically trained, I don’t think they really understand the full impact of what is going on and being done to their loved one and the impact it has on the patient.
It’s often a case of because they can rather than they should (doctors in ITU). What is done in ITU to keep a person alive is an actually pretty brutal. One of my consultants equated it to being like torture. Research shows that the longer a person spends in ITU the poorer the long term outcome. If they’re lucky, they may make it out of ITU but how long they survive for after that is another matter (Derek Drapper).
I don’t know what the answer is but I have worked in a lot of different ITU’s and my experience is that enormous effort is always made to preserve life no matter how futile it seems. To give the patient a chance and when it is clear there really really is no hope- then it goes in to palliative. From my experience, moving to palliative care is not rushed decision.
As for DNR- that just means that if a patient has a cardiac arrest, we don’t do CPR - that’s all it is. This does not impact/ lessen the current treatment the patient is receiving.
A DNR is put in place for people who it is deemed would not survive a cardiac arrest due to the fact they are already so sick with multi organ failure: all their systems are already kept going by machines or very high levels of highly potent drugs. if we were to do CPR during a cardiac arrest, they won’t survive at all but they would have a very traumatic death with people pumping on their chest and undoubtedly breaking ribs and causing more trauma in the process. All this and they’re going to die anyway.
DNR does not mean cessation of treatment, it just means no CPR in a cardiac arrest.
finally, yes I have seen a few ‘miracles’ where someone who I never expected to make it out of ITU has, but they are very very much in the minority.
My experience of ITU is no stone is left unturned to keep that person alive- that is our duty.