Doctor reccomending DNR

[B0yMama2]

I was in hospital all day with my 85 year old grandad after he had an unresponsive episode, my mother is next of kin and has power of eternity but she is out the country. My grandad has dementia but understands things going on arround him.
The doctor infornt of my grandad questioned why there's not a DNR on his medical notes and strongly advised me to tell my mum to put DNR on his medical notes. My mother said when he has no life meaning she will but at the moment he enjoys life, drinks, eats, walks with no issues and goes to the toilet with little assistance. When he can't feed himself, communicate or do anything for himself then that is when she said she will put a DNR in place. I'm just upset that he discussed to not save my grandads life infront of him, luckily I shut him down qwickly before my grandad caught on with the words it is my mother's choice.
I was also shocked at the amount of nurses I had to remind he has dementia and isant going to know when his birthday is or what his address is.

Who said all adults should be DNR? Please quote the person who you say has said this as you think it’s okay to call them names.

It's the second post on the thread after the OPs

It was @Mum2jenny

A DNAR is entirely appropriate for an 85yo with dementia. Discussing it in front of him, especially in such a blunt manner, was tactless in the extreme.

Sorry, but I did smile at the thought of someone having Power of Eternity. That really would be a superpower!

You know I really think it would be helpful if we were all offered some sort of interview at state retirement age with a social worker to go through this stuff. While most people are still reasonably well. They could advise/explain on making a will, retirement benefits/money, having funeral arrangements in place, health and treatment wishes/DNR. I bet it would save the state money and make better lives for people as well.

I can just imagine the screams of objections about this idea from people who must somehow believe that they and their relatives are going to live forever though.

Dnar is a medical decision its not something we ask of a relative, we don't want to put them in that situation

Cpr is brutal and wouldn't be survivable in such an individual, for this reason it isn't in an individuals best interests to offer it.

I wouldn't dream of wanting to be resuscitated over the age of 70 it's the worst possible way to die

It doesn't mean we don't treat them, we treat with absolutely everything possible until the point that the heart was to stop, then we wouldn't try to restart it, we would alow a natural death surrounded by loved ones in peace

It's totally appropriate, but it sounds as though the way it was explained was wrong, for that I'm sorry in their behalf

This explains it well

Thanks I found it. I don’t agree all adults should be DNR either. Individual assessment and choice must play a part.

When you say you treat everything possible, I actually think that's a problem as well. A friend of mine had a relative in a care home for about five years, she had advancing dementia and spent the last three years screaming in terror because she didn't know anyone, where she was or what was happening. She also had multiple painful medical conditions. This relative was first in the queue for every vaccination going, every ailment treated with antibiotics and every effort was made to keep her alive as long as possible. It was immoral if you ask me and I don't know who could be described as benefiting from this (well, I suppose drug companies). It was also massively distressing and stressful for the family. Relative died in her 90s, I don't know what of in the end.

I'm guessing he wasn't a frail 85 year old with dementia. A detail that you're conveniently ignoring.

I agree. Prolonging life with antibiotics when people have advanced dementia is not good practice IMO.

err .. that's a bit harsh!

whether resus works or not depends on a lot of factors. making all adults dnar would be criminal. many lives are saved by cpr, especially if it occurs in hospital.

@B0yMama2 it's normal practice to discuss dnar with patients if they have capacity. as you said your grandad has some understanding of what is happening around him it is only right that medics attempt to discuss it with him. although sounds like this medic may have been insensitive in his approach. at your grandads age, cpr is futile. all other treatments will still be given.

@RB68 I was thinking how sensitively and well written your post was on DNR and read on regarding your own families experiences. Thank you for sharing those personal stories here, It’s information like this that can help people make informed decisions.

I'm perplexed as to why you think it was inappropriate to talk about this in front of your grandfather. Surely his wishes should be the primary consideration?

When my DF went into hospital in his early 80s he had a DNR put on his file. It was hard for me to deal with.

In his late 80s he went in with severe pneumonia and it was clear that he wouldn't survive it, as he required a ventilator. He still had his DNR but the nurse on night shift didn't see it and he was resuscitated- she was devastated when she realised what she had done. He lasted a few extra days and it gave time for all of his DGC to come into the hospital to say goodbye.

I don't believe he was in greater pain due the CPR, but he was already on very strong pain killers.

In the end he passed away, with my DB and one of my DSis by his side with their hands holding his gently. He smiled at them, closed his eyes and died peacefully. It would have been awful if he had died while they were attempting to resuscitate him again.

My late DM had dementia (mild) and she was asked about a DNR in a rest home, aged 86. I had POA, and was there at the time, but ultimately it was her decision. My late DF insisted he wanted a DNR. It usually comes from the person themselves, unless they are incapable of understanding, so I don't see why it was so terrible to mention it in front of your granddad. CPR on an elderly person is brutal, why on earth would anyone want their family members put through it?

Seriously??? A man I went to school with was resuscitated a few years ago, in his 60s, and is absolutely fine now. I'm sure he and his family would disagree with you.

It isn’t ageist. It’s just that the outcome is very unlikely to be positive the older one gets so age is one relevant element that is factored in when making the decision.

I'm sorry your grandfather is unwell and think the doctor probably shouldn't have discussed this in front of him. However, it does sound as if your mother thinks a DNR is only needed when somebody has very little quality of life and that's not really the case. As she has Power of Attorney it would be a good idea for her to have a discussion about what it involves when she is back in the country.

You cannot force medical professionals to undertake any treatment against their judgement. You may not agree with a DNAR but you are not given the ultimate choice.

CPR is brutal and causes trauma, especially in those who are elderly or frail.

It is a perfectly reasonable thing for a medic to raise and if your grandfather still has capacity or understanding, you should absolutely be discussing it with him.

If your mother has Power of Attorney for Health & Welfare, she should already have had the discussion with your GF and his GP. She also should have spoken with your GF about possible health scenarios as his dementia progresses and how he wishes to be cared for depending on the circumstance, so that she is able to advocate for him correctly.

OP I'm sorry you've been put in this position, especially while your Mum is out of the country.
We had similar discussions with hospital doctors re my Mum. They had had the conversation with her first, but then asked me about it separately as I have PoA and whilst Mum has some capacity, they didn't feel she had enough to make the decision entirely on her own. I understand why you are upset that they discussed it in front of him, but perhaps they felt he had enough capacity to be involved in the discussion, if not make the final decision.
Interestingly, she had agreed to DNR. My siiblings ans I initially said no as she has a reasonable quality of life, albeit with dementia. The doctors explained that in the event that her heart stopped, resuscitating would almost certainly not leave her with the quality of life she had previously, would almost certainly result in cracked ribs, possibly then a punctured lung and worsening of her dementia. We discussed it first with a cousin who is a doctor. They reinforced that position. Both cousin and hospital docitor said what PP said - that the reality is not like TV and movies, and there comes a time when you have to let them go out of love and kindness, and with dignity. I'm encouraged that so many other people on this thread have been given the same information.
Whether you discuss with your Mum while she's on holiday or not is up to you. In my case, I was also away when the discussion was had and although it's not ideal when you're away, I was glad that my siblings did contact me. If you decide not to discuss with your Mum while she is on holiday, it's important that it is discussed asap on her return and that she speaks to the GP about documenting her decision.

To the PP who said Obviously it does depend on age and medical condition, but no way would I approve of a DNR on a OPA. But that’s my choice. why would it be 'no
way' - you said yourself it depends on age and the medical situation?

One thing that the DNR discussions did for me, as sad and difficult as they were at the time, was that I had to face the reality that Mum is becoming increasingly frail, her dementia is only going to get worse, and should her heart stop, we would not be doing her any favours by resuscitating. If that even should ever arise, I will cling on to the words 'out of love, kindness and letting her go with dignity.'

Keep talking OP if it helps, I know how hard and sad this situation. Is x

Years ago my 96 year old grandmother had a heart attack. She had dementia but was living semi independently. She had never been asked her views about resuscitation so there was nothing in place, so medical professionals had no choice but to try to keep her alive. The ambulance was summoned, she was taken to hospital and worked on until a spark of life returned. She then spent three horrible, miserable weeks in hospital until she died. If only she had had a DNR her life would have come to a natural end with the heart attack in her own home and she wouldn’t have had to suffer.

This is awful I didn't know this is what they did now or even in the past few years. Last I knew it was the Liverpool pathway if anyone took ill and they changed the name I think to end of life care.
Doing this to people is not right, not at that age.
I'm sorry for your loss I feel we might have this coming with my gran, she's in her 90s in a care home and it's never been mentioned. I don't think the family are even aware anyone would try and prolong her life. She's had enough though.

I'm sorry your Grandmother and your family had to experience this. It is such a difficult and complex subject but so important that it is thought about and talked objectively and with the best interests of the patient first and foremost. It's too easy to put our own feelings first - no one wants to lose someone they love dearly - but we do need to be aware of the harsh reality.
Thank you for sharing your story, it reinforces that we made the right decision and hopefully will help others too. Hope you can take some comfort in that x

@Unforgettablefire My granny died twenty years ago, before, I think, we were really aware that we could state our wishes. I certainly hadn’t given it a thought or discussed it with her.
Don’t worry and I am sorry if I’ve caused concern - thanks also for your kind words. I still miss her.