to think that "Do Not Resuscitate" procedures are just Euthanasia in disguise?

[LadyBlaBlah]

My dad was poorly with cancer. He had been given about a year to live. Unfortunately he got pneumonia. As soon as he was admitted into hospital with the pneumonia, a big red form was thrust onto us saying "Do Not Resuscitate", and so this meant that in the case of cardiac arrest, they would not intervene. The form was placed in the front of his notes, in full view of all (including my dad)

I am amazed this is legal.

The doctors said to us that it would be cruel etc to resuscitate someone whose body was so weak and I get that. But is that not a decision that doctors should take at the time of a cardiac arrest? And not something that needs to be defined so definitely before it happens?

For me, it is just a form of euthanasia. AIBU ? And possibly emotional?

To be fair to the doctor - he said it was HIS decision exactly for the reasons you have outlined wearthefoxhat - he did not want relatives to have the decision on their shoulders.

i am really sorry about your situation but i think it's very important that this decision should have been made before the moment of crisis - the last thing you want at that moment is uncertainty.

i think this should have been handled MUCH better with you and the rest of the family and much more discussion entered into.

ultimately though i am sure the doctors had your father's best interests at heart - resusitation can be very very traumatic (including broken ribs etc) and if the patient is not strong enough to recover from that then there's little point putting him and everyone else through that.

I think I understand that DNR's can be beneficial, although I am still not convinced they are totally necessary. And just that it gives a lot of power to people, yet the guidelines seem muddy.

That link has an example of a 67 year old who found a DNR on her record without her consent and was horrified. My dad would have been horrified too. I know that, because he thought he still had a year to live, right up until he died.

I don't think I have been convinced that the doctors acted respectfully and legally still. They would not take it off his file ( I asked them to ) and thus I think they never got consent.

I'm quite shocked that a single doctor was able to make the decision - I always thought that the decision was made after having a meeting with all the carers (dr's, nurses etc)
It does sound like this has all been handled very badly indeed.
Is there a dr who oversaw your fathers treatment who you could talk to?

When my gran was DNR, it was a very strong medical recommendation but not their decision. They explained the reasons and we agreed that in her case with massive septacaemia, multiple organ failure and pneumonia there was a limit to what would be achieved if she was resusitated. Defintely our decision though. I would suggest talking to PALS at your local hospital as a starting point.

i worked in hospitals for 12 years and a DNR decision isnt one that isnt taken lightly. It isnt normally just one doctor making the decision - it will have normally been dicussed in the team that are caring for the patient.

It is defintitely not the same as euthanasia. It is a decision to not rescusitate someone who has actually died from natural causes. Unfortunately people die and as hard as it is for loved ones there are situations (like you're fathers) where they have a terminal illness and to rescusitate them would possibly not be successful and even if they did survive they might have suffered in the process.

I understand that you feel emotional about the situation but hopefully you had the chance to spend time with your father before he died and that his death was peaceful in the end.

LadyBlaBlah, DNR orders are made by doctors, and although good practice would be to try and help a family understand the reasons behind the DNR, in actual fact doctors can & do make DNR orders in direct conflict with the wishes of the patient and their family.

You say that your Dad had a year to live, but pneumonia is a devastating condition to anyone with already compromised health. A doctor's first obligation is to 'do no harm'. Resuscitating someone who is weak may be doing more harm than good.

It really isn't like on the telly. I witnessed the resuscitation of a man with cancer, where the doctors did not decide that he should be DNR beforehand. But, when it was very clear that following his resuscitation he was likely to arrest again within an hour, they issued a DNR. As a care assistant at that time (later trained as a nurse), I spent just over 30 minutes tending to his resulting traumatic injuries as he died. Not a dignified death. I knew then that as uncomfortable as it makes me, DNR exists for very good reasons.

It is cruel to resuscitate someone who will not see a benefit, and I sometimes think that patients are left without DNR status because doctors have felt too scared to have difficult discussions with families. Patients can be resuscitated for relatives' sakes in the end, which is awful .

I wonder if in hindsight, you might imagine those last moments with your dad, if he had been caused injury by being resuscitated without success.

Some patients also have NfA orders. "Not for Antibiotics". Particularly stroke patients who would be likely to die if they contracted a severe chest infection, for example, without treatment choose not to have antibiotics so that their illness would take its course, for better or worse.

I am sorry to hear about your Dad.

The decision to not attempt recusitation (the word attempt is important because in the majority of cases it is not successful) should have definitely been discussed with your Dad if he was well enough to have the conversation. If he was not well enough then it is good practice to discuss with relatives as well.

However, the final decision rests with the consultant (and his or her team) who is in charge of the person's medical care. It is often a complicated decision to make and does require knowledge about the underlying disease, the person's general health and the likelihood of a resuscitation attempt being successful. This is not something that the average layperson could (or should) be expected to know. It is unfair to expect a family to make this kind of decision and it can sometimes lead to guilt that they have made the wrong choice and 'allowed' someone to die.
Lou made a very good post above about the potential trauma of an unsuccessful (or even 'successful') resuscitation and it is often much kinder not to put someone through that. Sadly a terminal illness is just that and it is just not appropriate to attempt to prolong someone's final moments, often with painful and invasive procedures.

"No it's not a form of euthanasia, to not stop a person from dying when they are is different from causing a person to die when they aren't."

I agree with this.

I've got several friends who are hospital doctors, and they're quite depressed at how TV has made people think resuscitation nearly always works. It doesn't. It almost never works. It takes away a dignified death and introduces pain, confusion, upset. And still, most of the time, death.

There's a book by a junior doctor, I can't remember the title, but in it he describes how he once failed to see a DNR order and brought in a crash team to attempt to resuscitate an old lady. She still died, but her ribs were broken and all dignity was taken away from her - and her family were there at the time and saw it all. The doctor said that in all his medical career he felt that was the worst thing he'd ever done.

It sounds like this was dealt with really badly, but DNR orders are about respecting a person and giving them the right to a peaceful death, they are nothing to do with euthanasia.

My father did not have a DNR when he was dying because my mother did not agree to it. The night before he died he went into cardiac arrest three times. Several of his ribs were broken in the process of resuscitation. For what? Nobody in our family has a medical background and I don't think any of us realised what a violent procedure resuscitation can be. If we had, we would certainly not have allowed it to happen. My father's kidneys had failed, he was on a ventilator, he had no prospect of recovery, the only thing still going was his heart and he wasn't allowed to give up the struggle until we finally persuaded my mother (who was in such a state of shock that she was incapable of absorbing information or making a rational decision) to allow a DNR.
Relatives are not always capable of thinking straight when confronted with impending bereavement, and like us, do not always understand the implications of resuscitation. I think my father would have suffered less if we had known more.

I am so sorry to hear your dad died, Lady.

It sounds as if you have already questioned the doctors in questions thoroughly about any reasons for why they took that decision.
My DH is a doctor and he would never take a decision like that lightly. But he would also be very pragmatic about how much a proceedure would benefit a patient balanced with how much harm it could cause.

I hope you find some peace over this decision. You must be so upset that you thought you had another year with him.

I am quite shocked by the number of people on this thread who have been given the decision on whether or not to resuscitate a close relative.
This is absolutely not their decision to make, as I said upthread. It is good practice to involve them in the discussion and to make a decision that everyone feels comfortable with. However, in the end it is the doctor's decision.

(It may be different in other countries but this is how things stand in the UK.)

it's nothing like euthanasia in fact it's quite the opposite. it is allowing nature to take it's course and death to come naturally in a situation where resucitation may only pro-long the suffering of a patient or cause trauma to the family. euthanasia on the other hand is inducing death before it would naturally occur.
you are understandably being tinted by the stress/emotion surrounding your fathers situation

Sorry FM, I should have made clear on my post that my father was not in fact in the UK, so UK practice did not apply.

lady, I am sorry about your dad

I want to echo a previous poster weho said resuscitations are not like you see on Holby City. They are often violent, prolonged, inflict pain and rarely successful (by the time it gets to that point, really the patient has died).

It is also worth mentioning that when a patient "crashes" (usually in the middle of the night), the resus team are often junior members of staff at the end of a 24 hr shift who don't know the full situation and this is really the worst time to be making a decision to resus or not.

It is much kinder in the long run for a DNR order to be upfront and ready for such an eventuality.

Lady, having worked in the field, I think a DNR is frequenty appropriate and should be organised in advance. However, there is something not right for you here. You said that sadly your Dad died and now you're remembering this stuff.

For the sake of your future peace of mind, I would strongly recommend you phone the hospital's Complaints Department and ask them to investigate. You are also allowed to apply to see his medical notes for a small fee.

My understanding is that he would be the only person who could make the decision, unless he lacked the mental capacity (dementia, mental health, learning difficulties). Please don't let this interfere with your grieving process - call them today, it takes 3-4 weeks.

Sorry for your loss.

That is the bit that is troubling me queenofdenial - and also the speed with which it was administered. I don't know, it made no difference to the outcome anyway, it just left an impression on me that was a bit suspect. He had just had major surgery a few weeks before to try to save him and he was deemed fit for that.........I don't know...........I do know he certainly was of sound mind - right up until his last minute.

Do all terminally ill patients have DNRs?

You know what, I think I just got what it is that is fucking me off..............Dad had a massive operation (Whipple) which was a total disaster and ended with him nearly dying 5 days later when a feeding tube kinked his bowel, and so he had to have another major operation to remove his bowel.........and basically his body was weakened so much from these 2 massive operations within 5 days of each other..............that he was so very weak...........and so, in my head THEY, these doctors, fucked up his body, and then they turned round a few weeks later and said, sorry we are not gonna save him if he has a cardiac arrest...........and actually the whole reason he was so fucked up was because of their operation that went wrong.

Oh I am so very sorry for your loss ladyblablah.

I totally understand how angry and upset you must be feeling, like you say, its not about the DNR at all. Maybe you need to talk to someone professionally who could advise you if there is any recourse about the operation? Did it just go wrong? Sadly, there are often complications and they cannot be avoided, but if you have any doubt, you need this cleared up for you otherwise it is not going to go away.

I lost my dad to cancer and alhzheimers and I was totally adamant that i wanted no treatment appart from palliative care - thankfully the doctors and my mum agreed, because my poor old dad had suffered enough with the alzhiemers its like the cancer was a release for him (if one can ever think of it like that).

Is there a PALs service at the hospital, maybe they would be your first port of call, or cruise bereavement care - just to point you in the right direction to get the answers you deserve.

My great-gran was 94, very frail, and in and out of hospital. In the end the doctors decided that really there was nothing that they could do for her and the "kindest" thing to do would be to let her pass away. I was horrified that this meant withdrawing all food and drink. They told my step mum that it wouldnt tak very long, as she was so old and frail - 3 FUCKING WEEKS IT TOOK. It was hiddeous.

Anyone that starved/withheld water from a dog would be prosecuted, but apparently its perfectly legal for the HCP's of this country to do.

TBH Lady from your later posts it sounds as though the doctors got it right. It sounds like he was just done, would you have really wanted them pounding on his chest and hurting him even more to maybe get another hour or so?

My Dad died of cancer when I was 14 so I do understand, but medicine isn't magic, sometimes really hard decisions have to be made and relatives are not the best people to make them.

You really need to talk to someone professionally I think.

Not all patients with cancer have a DNR but i think all patients who are have been given a terminal diagnosis should have had it discussed although as some other posters have said, the doctors can make the decision then inform the family.

i understand that you're justifiably upset that your father had a really terrible time in the last few weeks of life but I think the only place you'll get your answers is to ask to look at his medical notes and if possible speak to the consultant who was in charge of his care.

unfortunately you sound so upset and angry at the moment that i doubt you'd be able to actively listen to what they have to say.

Think you need to take some time to grieve and then make a plan how you're going to have you're questions answered.

sorry about your father.you can request to meet his consultant and discuss the DNAR order.also you should request the trust policy on DNAR and the criteria and guidelines.DNAR is not undertaken lightly and your opinion should be heard.they should fully discuss the clinical decision.CPR is also dependant upon the physical condition of individual,and any other underlying conditions

who was consulted about this DNAR?were you aware or did you find out by seeing the documentation

Resus Council DNAR guidance

I think that people should make their own decision and ask the doctors themselves of through an advocate if the want a DNR not have it put upon them. However Drs do have to make life3 and death decisions based on various factors and if they think that recusitating someone who is a few moments away from death is fruitless and will help then they have to make that decision i am afraid. My dad died of cancer and so did my gran in in those last stages i would not have liked them to be recuscitated myself just to let nature take its course.