Do not resusitate order - family informed?

[petiteonion]

I live a long distane away from my family but try to get home as oftern as I can.

my father has COPD, Asbestos and other conditions relating to s lings and breathing. He reallu is quite ill with frequent hospital stays. my mum is his prime carer and she is struggling.

No-one has went through what my dads illness really is, what stages it is at and any discussions about what will happen next. we know he is ill but not a real picture of what it means for the next months. I doubt he has a year.

I was home last week and it coincided with another hospital stay. I tried to get to speak with a doctor but no-one was available at any stage. A doctor rang my mother yesterday saying that a family member has asked for a call so he was following up. In a very off hand manner he said that they were running out of options to treat him and that as a DNR was signed - there will be little emergency interventions in the future.

I am not saying a DNR is not appropriate but this has never been discussed with any of the family or my dad. I know the doctors can override a family's decision but we are not contesting it but wondered why no-one had let us know this had been agreed.

I thought we had to be informed?

Op Im in NI. My mum died in the Royal.

The day before she died the Drs spoke to me alone to get the family opinion on resuscitation. I was the one there at that point, the Dr asked me what myself and my sibling's thoughts were and I gave it straight. Mum was to be DNR. No question.

We also agreed to a post mortem as well, as there were several questions over what actually was wrong and she was too ill to test for some of them. We got our answers from the post mortem.

Everything was failing and she wasnt able to eat, drink (despite many hours of persuading), she was gasping for breath even with the oxygen mask on, her heart was in failure, her lungs were drowning in fluid, her kidneys had failed and other problems. Her lungs had already been drained many times and were getting hard to do repeatedly.

She had already made her peace that she was going to die and as a family (without her) we had made the decision that as there would be no chance of prolonging life and that resus was futile overall, so not for resuscitation and keep her comfortable and call us at any time.

There were 5 teams of Drs involved and they all agreed with us.

I was home that night at 2 am, my phone rang at 8.57, to come to the hospital, my brother got a few words from me on the phone and we both made our way to the hospital and we held her hands and talked to her until she passed. The last thing she saw/heard/ felt was us, and we talked right to her telling her we loved and her job was done, she was free to go meet my father (she literally faded at this).

I asked my brother to push the button for the nurse as it was on his side, I had kept my fingers on her pulse and felt it fade. The nurse checked her pulse for us and it was gone. her death was recorded shortly after. It was peaceful and loving and with the 2 she loved the most in the world supporting her.

CPR would have been invasive and prolonged and she would have been without us, alone being worked on for something which didn't stand a chance to help, would only prolong things in this case and would cause severe pain until the next attempt.

However, if we had thought for one moment that there was going to be a life afterwards we would have fought for her every step of the way.

It was a good death, with those who she loved supporting her and no intervention as it wasnt going to help just prolong.

Yes, with your dad's permission ask all the questions you need to and good luck. If you want to pm me or anything, you know where I am

I've spent a lot of time over the last few years persuading extended family about the merits of a DNACPR form.

People die. Especially when old & crumbly (like my grandparents). CPR in that situation is torture.

DNACPR does not mean stop Care. Although I do think we sometimes need to assess the impact of likely interventions eg. My grandfathers final illness was pneumonia. My aunt wanted him to go to hospital for IV antibiotics. The rest of us pushed for being quietly managed in his room at the Care home by the staff that knew him and us. It was much better than dying on a busy medical ward. I don't think IV antibiotics would have turned things around and even if they had he had told us repeatedly in lucid phases that he didn't want to be alive anymore.

Everyone needs to think and talk about these issues. Not enough families do.

I should point out that while I respect what billinisurge says, it might be inadvertently misleading, because it makes it sound like her parent opted to go to Dignitas or something, or made some unnecessary decision. As far as I'm aware, the DNR does not mean 'oh, you've had a heart attack, so now we're going to let you die' though it also depends on all kinds of other things, so if the person has significant dementia, and generally suffering all round, as was described on page one by someone on this thread, then legally and ludicrously, the State has a duty to save that life anyway, or be held legally responsible. Even if it means prolonging that life beyond its natural timespan, as science can do that.

Now, it turns out I'm now being misleading, because you'd think if that were the case, folk in care homes might be treated better but not a bit of it. From what I've experienced, it is clear to me that some Surrey care homes, for instance, are secretly tasked with killing the elderly off via dehydration. All they need is 'severe dementia' scribbled on the medical notes, and they can go ahead with it, it seems. a) The family need not be informed and b) Your parent need not have 'severe dementia'. Just so long as it's on the notes - which you can't see if you didn't get LPA in Health and Welfare when you could - then that makes it true.

So, just because there's this pernickety legal finessing in A&E regarding end of life, don't imagine for a moment that applies in care homes. It's the wild west out there, with no sheriff in town, and different rules apply.

Sorry, that was a bit rambling, wasn't it? What I mean is, someone being DNR doesn't necessarily mean signing their death sentence there and then, any more than making a will means they're going to die at once. It's for the future, hopefully. That said in any care home situ I'd have it plastered on the walls for the visiting paramedics just what would be DNR and what isn't, for the avoidance of doubt.
Just in case they jump the gun.

Resuscitation is a violent and damaging procedure with a very low success rate, op. For someone in your father's condition it would be fruitless to even attempt it. Surely a relatively peaceful end is what we all want - and what you and your Dad would want. I'd ask your GP to talk to him, if he is questioning this DNR decision .

DH requested a DNR after speaking to the medical team about what lay ahead for him. I was devastated at first and felt like he was giving up, but the last few days of his life were so traumatic for him that I could understand why the doctors had recommended it and although it took all my courage and love not to attempt CPR when he stopped breathing, I know he died peacefully in the end with dignity. for you, it really is difficult. My DH had COPD, lung cancer and brain mets, but what actually killed him was a double dose of pneumonia and sepsis because he was unable to cough the infection up, which led to hardened deposits narrowing his airways and suffocating him. In those circumstances, he would never have been able to recover, and resuscitation would only have prolonged his suffering.

I am not saying a DNR is not appropriate but this has never been discussed with any of the family or my dad

Wot @Birdie6 said:

Resuscitation is a violent and damaging procedure with a very low success rate, op.

Can you honestly be absolutely sure that it has not been discussed with your father?

I am not sure whether you are aware but your allegation, if well founded, is an exceptionally serious, potentially career ending one for the doctors in charge

Is your father judged to have capacity to make decisions for himself? Have you been given access to read his medical notes ?

DNR by no means means that no further treatment will be provided. It is all about not leaving ill people with broken or damaged ribs on top of everything else, with very little chance of success as PP have already made clear.

Getting good information can be quite the challenge across a family, especially if you are not around for all the consultations. While your father is judged to have capacity, he is the person who will be consulted. Do you have POA in place ?

Going straight to accusing the medical staff of putting on a DNR order without consultation is not likely to help anything

You are going through a very difficult time as a family. Take care of yourself, take time to breathe and avoid jumping to conclusions can help to make a very difficult time at least not worse