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.

@kerstina he may not necessarily have had a cardiac arrest to have needed a ventilator. what does it say on his death certificate? You can order a copy if you don’t still have one, or you could contact the hospital and request some details, it may take some time though, but it would save you wondering forever more.

Op my DF has dementia, not too bad at the moment, knows us all fine but needs care. I’d love the sibling with POA to put a DNAR in place. I have also made it clear to my own DC that, should I get dementia, I have an advanced directive in place to make sure that I be made comfortable but not receive treatment whether it’s for pneumonia, UTI, chest infection or whatever. I don’t want to be kept alive indefinitely to suffer the indignity of full blown dementia like my poor DGM did. I was slightly upset when DH had the DNAR added to his own notes, and wish more than anything that he was still with us, but I know that even attempting CPR on him would have been cruel beyond belief if he’d survived it. There’s nothing positive about keeping people alive at all costs. The life they have to live afterwards needs to be thought about.

My mum arranged her own DNR. Sounds very much like your gran. Independent with no dementia. She was very clear that she did not want reucssiated.

she used to wonder how she would ever die, as all the treatment and tablets were keeping her alive “too long” and she was getting quite angry about that.

she had a heart attack in the privacy of her own home, and I think she would consider that a “good death”. Nobody else there to interfere!

I think you need to discuss with the doctor what life is generally like for people after resuscitation. It’s an extremely hard thing for a body to go through.

I cannot ever seeing me approving a DNR ahead of time as it surely must depend on the current circumstances

Arranging a DNR ahead of time is literally the only option, lol. Not having one means that the medical team will immediately start cardio-pulmonary resuscitation. A decent team would hopefully make an early decision to stop the resuscitation if the patient was clearly frail and unlikely to make it out of hospital. It’s one thing to get a pulse back and the patient be “alive” - it’s another entirely to move into post resuscitation care in ICU, and then survive the next hours/days/weeks/months.

As explained above in one of my earlier comments, current circs are largely irrelevant, of those very few people who do survive a sudden cardiac arrest, fewer still return to normal life exactly as they left it. Even young people who survive a cardiac arrest can have poor neurological outcomes meaning they need carers, mobility aids, cognitive help, some even need 24/7 care in a nursing home (I used to work in a young persons neuro/spinal injuries unit, there were some really unfortunate situations where people had survived the cardiac arrest, but left unable to do anything for themselves, bed bound and furious at life, due to hypoxic brain injuries caused by the cardiac arrest, etc). For an elderly person with existing physical frailty, chronic conditions, maybe some degree of existing organ failure, etc - chances of returning to their lovely life of pottering and independence are incredibly slim.

I think films and TV have given the public an unrealistic view of cardiac arrest/CPR - I think people might expect that they have a few half hearted chest compressions, immediately get a pulse back, the person is spontaneously alert immediately and going home the next day. Most of the time when you do get a pulse back, the person remains unconscious for several days, if they ever regain consciousness, is intubated and on a ventilator and the prognosis is generally grave.

I’m not saying we shouldn’t ever resuscitate anyone, but I think we should be a lot more selective and realistic. But it isn’t a failing of any individual family to not their relative to have a DNAR, it’s a failing of the system, media, medics, etc to not have explained in a understandable way the use/implications of them.

It's not really a case of approving it's a case of being involved in the discussion re a relatives wishes and out of courtesy. It's a medical decision as some people think we can live forever and that despite our bodies failing as we get above 75/80 yrs life should be artificially prolonged on ventilators. If only we could live forever, great but that's simply not reality. The body fades and organs fail even in reasonable health, once serious illness takes hold, temporary cpr or use of a ventilator won't revive a person or keep them alive to recovery.

It's too late to have the discussion when resuscitation is needed, the whole point of a DNR is that it is discussed and agreed ahead so doctors know whether to attempt resuscitation if/when the need arises.

If someone is already extremely frail and is not going to get any less frail, then why wouldn't you at least have the discussion? It's a horrible thing to have to think about and agree to, but the alternatives are far worse.

It's interesting that on one thread people are saying they want a good death and even talking about the extreme of assisted dying and on another thread people are resisting DNR discussions and decisions even when medically decided/ indicated which can lead to prolonged interventions/ suffering.
There's a huge level of ignorance around all of this and then the media hypes things up and people don't trust the doctors. A few years ago after the Daily Mail terrified everybody the end of life pathway was taken away- actually only the name changed - the Liverpool EOL care pathway was changed to Integrated care pathway.

It’s normal OP. Happened to my 86 year old uncle fully cognitive at the time. He wasn’t best pleased- he had complications of COPD and covid. (Made a full recovery).
Also his 65 year old son, had heart issues and a broken hip. Fully cognitive but very unwell.
Needed two ops for a stent and the hip. He wasn’t very happy either! but has also recovered.

If your elderly is already unwell, any event that requires resuscitation could mean IF he is brought back he will likely be in a vegetative state. (This is what the doctors told my aunt- I wasn’t there).

For a resuscitation to be needed imo the worst has happened. Had a quick look at stats, so they’ve got about ten mins to bring you back and you should be ok mentally (couple of rib fractures) 32% of people are brought back. Don’t know the ages or conditions of these people, as I didn’t go into it.
If I were given the option I’d go peacefully, being in a vegetative state is my idea of pure hell, along with suffering of any kind and the inability to recall who I am. I’m around for me, not to make others feel better and I want them to remember me for who I am, not what I’ve become. (I fully support euthanasia also).

@B0yMama2, you're absolutely right. Its wholly inappropriate to have had the discussion with YOU and in front of the patient

The person to make the decision with the doctors is the Power of Attorney (your Mum)

And the discussion should be had privately away from the ward and away from the patient

I've had 2 experiences of this - me being power of attorney in both cases

First in 2013 was handled perfectly and with sensitivity

Second, last year, so 10 years later - in the same hospital - was handled appallingly

I assume the change is because the NHS has been allowed to crumble by the fucking Tories

I think @B0yMama2 that it is appropriate that your grandad has a DNR (now called reSPECT) but it is not your decision to make

🥰

Dh and I have similar added to our Health and Welfare Powers of Attorney. In certain circs*, not just no resus, but no life-saving or life-prolonging treatment.

*dementia, or any other condition where we are unable both to care for ourselves, and speak - with full mental capacity - for ourselves.

I agree.
People seem to think that they and their relatives will live forever.

My mum had a fall at 70 where she broke her ribs. The dr asked if we wanted to sign a DNR as attempting resuscitation would if successful leave her in a bad state.

We didn't agree to it but it’s actually good to get the discussion in early,

If someone is terminally ill with cancer and their heart stops, doctors don't rush in to attempt CPR. It would be inappropriate as the person is terminally ill.

Old age eventually becomes a terminal illness. The heart, circulation, brain and other organs, bones and even skin become weak and don't function as well. Eventually the heart stops. Just as with a cancer patient CPR is not appropriate as the chance of a positive outcome is small and the person will not make a recovery from their other health issues and age.

I agree.
The discussion ideally should be done years earlier while the person is still in good health, not in the panicked heat of emotion.