Children or their parents being asked to sign DNR

[Daddypigglasses]

Is this true. I’ve seen a few articles on line where the GP have asked them to sign one incase they catch CV.

Not sure if it’s just media hype or it’s actually really happening.

I don’t even agree it’s ok for any kids tbh bit do you think this would also apply to children who are sick from CV?

The youngest I’ve seen is a 13 year old boy dying with no apparent pre existing health conditions. Are children younger than this getting ill with it as I can’t find any?

My anxiety is a bit bad today. Can anyone come and explain this or even say it’s not true? There is also articles saying that if children get CV they are in isolation by themselves and parents are not allowed in. Is this true?

So many rumours it’s hard to see what’s fact and fiction.

Any links or facts would be helpful thanks

This DNR stuff has got blown up a lot.

The bottom line is that no one can ever force anyone in to signing a DNR. There are many, many circumstances where it is appropriate to discuss it. For people with life-limiting illnesses, or who are very elderly, this will often be at a time when they aren't acutely unwell. It allows them to set out their wishes for when they do become unwell - and saves them from the indignity of CPR, broken ribs etc if they would prefer to be allowed to die peacefully.

For usually healthy people, it will sometimes be appropriate to discuss DNR with them (or in the case of children their parents) at a time when they are very acutely unwell. It is when it reaches a point that further interventions are likely to cause more complications than they solve. These conversations have increased importance at the moment because of the potential pressure on resources. It is an unpalatable but unavoidable truth that constantly prolonging the life of someone who is very unlikely to survive may take away resources from those with a better prognosis. However if consent is refused, any and all treatment that is in a patient's best interests will continue to be offered.

There has been a lot in the media because health care professionals would like people to whom this is relevant to give due consideration to it in advance, because that is the best time to make try to make decisions, not in the heat of the moment.

A DNR doesn't mean you wouldn't receive active treatment right up until the point of death (although sometimes people might wish to put additional orders in place). A DNR/DNAR means that should your heart stop (ie. you die) they don't try to reverse this. To be completely clear - this is to stop them attempting to reverse death.

Now if you're in a car accident and your heart stops, assuming everything else is fixable you're brought back, they fix the other stuff and hopefully you recover. If you have an operation and lose too much blood and your heart stops they can bring you back, pump you up, finish the op and you recover. If you have CV and your heart stops there is still no treatment. They would be bringing you back to very likely die of another complication.

Resuscitation is awful. It's painful, it has a low success rate even in hospitals, it is traumatic for all involved. This is ultimately fear mongering by the media, but doctors are absolutely having this conversation with family up and down the country. It's not a case of letting people die because of staff/bed shortages, it's letting people go when their body can't take any more rather than giving them a more protracted and painful death than necessary.

www.rcpch.ac.uk/resources/covid-19-isolation-plans-parent-child-combinations

I've not heard about the DNR scenario. There was a lot of concern in the special needs community when NICE guidance was published about who should be eligible for ventilation because mental capacity was one criterion (from the dementia frailty assessment scales) but it was pretty swiftly clarified this did not apply to children or otherwise healthy adults with learning difficulties. It is much less likely that children's services will be overwhelmed as in general they seem to have mild symptoms with Covid-19 , so hopefully any tough decisions can be made case by case, in discussion with the family, just as would normally happen.

Rule of thumb should be that if you have heard news and there is no accredited source for that news then simply ask for one. If none is produced then don’t believe it. I am amazed at what sensible people are believing without questioning. Also choose two news sources eg bbc that you trust and read them frequently to keep yourself updated. You shouldn’t have to double check information on an anonymous forum. There is no guarantee that anyone knows any more than you, unless they can provide links to sources to confirm their point.

Ah I see. Thanks for replying.

One of the articles said a 16 year old was asked because he had regular asthma attacks. He refused to sign. If they had signed it would that mean they wouldn’t help him if he had a bad asthma attack?

I know there was a thread on here where someone had an 8 year old with cystic fibrosis and the parent was asked if they wanted to sign a DNACPR because if the child had a very severe case of coronavirus they would be unlikely to survive being put on a ventilator etc.

But as pp said nobody should be being pressured to sign a DNACPR and they cannot make you sign one. It does sound like some of the letters that have been sent out could have been worded better though 🤷‍♀️

No, as DivGirl says, a DNR does not mean "no treatment". It means "no resuscitation" - which means they won't try to restart a stopped heart, not that they won't treat an asthma attack.

The purpose of DNRs arent just to bump off anyone who has an underlying health condition.
They are to formally put in writing an agreed action plan if the person were to become so ill that they required resuscitation or medical intervention. They have to balance the value of saving their life versus the pain and suffering that resuscitation would cause. People dont realise how brutal it is to be on a ventilator - it can really damage your lungs and cause long lasting after effects and pain, not to mention damage to other organs. Now, in an otherwise healthy person- they can recover from it but when you have a person who is already very, very unwell, it might save their life in that moment but it will cause extra suffering and pain when their life expectancy isn't very long anyway. Thats why it needs to be considered - resuscitating everyone no matter the cost to that person's quality of life is an important ethical consideration.

Even manually restarting someone's heart via chest compressions can cause broken ribs (imagine how easily that happens in an elderly person with osteoporosis). Recovering from all of that when you are say, 94 years old, have dementia and cannot swallow due to dysphagia is put bluntly, cruel. In those cases, its kinder to let the person slip away without intervention.

There are no blanket rules and every case has to be assessed individually on its own merits. But ultimately, DNR are to prevent the prolonging of suffering and pain in someone whose quality of life is already fluctuating or poor. I think the majority of people dont realise how brutal resuscitation can be - they see programmes like Casualty where someone is shocked back to life and thats that. Its not like that in real life. Medical interventions have a cost and sometimes the cost just isn't worth it.

Was chatting to my GP family member about this. He has had to talk to patients in a care home about what they want. Introduced the idea of a DNACPR. It's not forced upon them. The conversation should be sensitive and if they want CPR if needed then they will receive it. These conversations happen all the time, but of course are happening more due to coronavirus. It's not a bad thing and as awful as it sounds, if you are so sick you likely wouldn't survive CPR or would be in a worse position if you did receive CPR, you should really have a choice. CPR is brutal. Really, really brutal.

XP with Alexis

Hey OP, a quick google brings up an article from The Sun (I know, I know) from 4 days ago which says that 5 children and teens have died in the UK of coronavirus. That was at the point where 7000 people had died of it in the UK. So of those 7000 deaths, only 5 fell in that age range. It's really unlikely that your children, assuming they are otherwise healthy, are going to be seriously ill with CV.

We don't know how many people have or have had coronavirus as we're not testing everyone but there was a thread on here the other day about someone whose daughter had a mild temperature one evening, but whose DP was a key worker who got tested, and it turned out that the daughter had had coronavirus, but they wouldn't have noticed otherwise.

As a previous poster said, DNR only applies if the person has already died. Resuscitation will even then only be successful in 10% of cases. The side effects where it is successful can include damage to internal organs, brain damage, broken ribs, and more. And if the thing that caused death isn't treatable then resuscitation isn't going to "fix" the problem. It's not like on TV. It's a horrible thing to be asked to sign but it's done with the best interests of the patient at heart.

Thanks for the posts

As @WashYourFins says Resuscitation is only carried out on someone who's heart has stopped beating - they are effectively dead.

The success rate is less than 10% for CPR outside of hospital. And that is less than 10% of those people who were 'for resus' - you have already excluded all the people who had a DNR, so all the frail people. So the success rate is actually really poor.

And what does success look like? It doesn't necessarily look like going back to your normal life, exactly as it was before. It may well mean being severely brain damaged.

Effectively the only 'good' results are for those people who have very few pre-exisiting conditions (or the right sort of conditions - generally cardiac only), and have a particular sort of cardiac arrest which responds to electric shocks, and get those electric shocks early.

I do DNR discussions all day every day as part of my job. Generally it is a medical decision as if there is no chance CPR will be successful, you won't be offered it. It's not a choice. If there is a chance it might work then there is a discussion, but most people having DNR 'discussions' are actually being informed rather than choosing. Actually I find about 95% of the people I have this conversation with don't want CPR at all, which is v much not how it's portrayed in the media. They know how ill they are, they want to die peacefully at home and once you explain the facts everyone is in agreement. Some patients have nearly ripped my arm off for one.

It's the same as any other medical treatment. We don't offer you chemo or organ transplants if they aren't going to benefit you. Resuscitation is the same.

My DM announces she wants to have one everytime she goes in to hospital. She's late 70s, has had serious sepsis 3 times. Last time they said 'well we're not really there yet'. Both me and my DM looked at the doctors as if they were insane - she has severe osteoporosis and if they tried chest compressions they would break all her ribs and crush her internal organs and she'd definitely be deader than she was before.

A lot of elderly people, palliative people or those with severe co-morbidites have a lot of common sense on this issue.

@caradelvigna it is standard practice on entry to care home for this to be discussed. Any care homes only.now just asking should be questioned as it is part of their doc

For the majority of patients, if they require so much care, they need to be in a care home with nursing care, the likelihood of them surviving CPR is remote.

Good practice would be discussing this on admission to the care home, and doing some advance care planning about preferences about hospital admissions, preferred place of death and updating this regularly as the person's health changes - not suddenly having a panic now there is a pandemic on and having a mad rush round all the residents because you didn't do it before.