I and two other friends on the vulnerable list have had slightly odd calls from the nurse in the local GP (we all have different GPs) - one was asking for next of kin, the others whether we have considered our options if we are hospitalised. One was eventually sent a Do Not Resuscitate form, if he wanted to sign it (he has had cancer in the past but now clear and a very active 72yr old).
One of them is going to contact the doctor directly and just confirm that if hospitalised, we can expect exactly the same treatment as anyone else and that we are not being "written off" because we are deemed vulnerable and old!
Is this happening more generally? I just wondered if others were having similar weird conversations - they start of very caring but then somehow move to slightly darker places.
Worried piaonoperson
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It was in the news say three weeks ago that this was happening in some places, and there was an outcry about it. I am also over 70 and I haven’t received any such message. I live in York. I too find this a worry. It makes me feel expendable.
Thanks - I must have missed this - not sure whether it’s reassuring that it has happened to others or not - but thank you for replying and understanding.
What an unsettling call to receive, I can understand how upsetting that would be. I do think though that we should all have an idea of what treatments we would and would not want if we were unable to vocalise that. A DNAR refers to quite a specific circumstance where if your heart were to stop they wouldn’t attempt CPR. CPR is a very invasive and quite frankly brutal procedure (broken ribs are very common) with sadly a very poor success rate (it is definitely not like what you see on the TV where nearly every CPR attempt is successful).
A doctor would ultimately decide if a DNAR is appropriate but they are only given if there is really no chance of that person surviving and they differ from other types of decisions over care. A DNAR does not mean that they wouldn’t try to prolong your life or that you wouldn’t be given other life support if needed just that they wouldn’t attempt to restart your heart if it stopped. Other discussions can be had about the level of care someone would receive and these can cover issues such as intubation, whether or not you would want to be admitted to ICU or for some people approaching the end of life they may have a ‘best supportive care’ approach where fluid and medications will be given but on a ward based level. Some people will have an advanced care directive where they will specify the level of care they would like to receive.
Luckily so far in the UK there haven’t been situations where there is so little capacity in critical care due to COVID that decisions are made not to admit people based on their age which I know has had to happen in some other countries and is really a tragedy.
Please don’t think that you are considered expendable it’s really not like that and I have regularly been involved in the care of people well into their 80’s on ITU so age is not an overriding determinant of admission to critical care, it would be based on the likelihood of survival and a meaningful recovery.
These conversations are difficult to have and quite frankly there is not much out there to help people decide. And there is a lot of misinformation which makes it sound far more cruel than it is in reality.
Thank you for the considered response - I do appreciate your thought and time to reply - and I really don’t have a problem with DNR and totally understand that there will be a point where these decisions are made - what worried me about these calls that the decision was possibly being made too soon - if you are on the vulnerable list then it is assumed that you are unlikely to make it and therefore do not require the same treatment/attention that someone not on the list will get
I also have a similar issue about the situation in care homes - those residents are not being offered the same treatment as anyone else and therefore do not get taken to hospital and then die alone - not because it’s deemed to be their time but because they are old and in a care home. Surely each DNR decision is individual and taken at the right time - not on the basis of a list or your age. I am mid 60’s I am asthmatic but cycle, swim, climb munroes (Scottish mountains over 3000ft) have an productive career and a loving family. I believe I am contributing to society and if taken ill would like to think I get every chance to beat it as the next person without any preconceptions coming into play
Oh goodness - I will get off my high horse now. Really, thanks for letting me have this chat it has helped a lot
I completely agree, any decision like that should be taken on a case by case basis and not applied to everyone in a specific category and if that is happening I would consider that to be appalling. I do think that any decision like this should be discussed with the individual if they have capacity and to find out their opinions, these conversations are important but I think that at times they are not conducted in a compassionate or thoughtful way, it’s evident from the responses here how emotive this subject is and if it’s not approached in the right way it causes significant distress. No one should feel they are being written off and it’s saddening that is how it makes people feel.
With regard to care homes unless they have a PEACE directive (used in advanced dementia) or an advanced directive then those people should still be taken to hospital and I hope that is happening as again it would be a disgrace if it’s not happening on a case by case basis.
My relative was asked this on admission to hospital for Covid-19. She's over 70 and she was asked if certain things happened would she like resuscitation etc. She said she wasn't upset by the questions as it meant her wishes were recorded. By the time resuscitation is pertinent it's too late to ask for the patient's permission for quite a traumatic intervention. Says alot about Covid-19 complications.
She was discharged but has been back for scans and bloods as damage to lungs needed to be identified plus it's necessary to see if any blood clots have been produced. Apparently in some cases damage has gone beyond the lungs and other organs have been affected.
Maybe some Covid-19 patients are already too ill to ask about DNR on admission to hospital. I've been in a position as next of kin having to make the DNR decision for someone else and unless you've had that discussion with your relative everything is down to you and second guessing what they would want - I really think it's better to have that discussion with the patient when they are in a position to make their own wishes known.
I agree with all you say. However, in some areas a short while back they seemed to be sent out routinely to peoples’ homes if they were deemed to meet certain criteria, like over 70. There was an outcry, and it should have been stopped. To have it seriously discussed with you is a different matter, rather than a kind of standard letter.
I definitely agree with that. Time to consider the whole matter after a discussion with Q&A is preferable. I reckon that some Trusts are going down the questionnaire route which is poor on many levels.
I know in the US some States are passing legislation to categorise patients in the event choices have to be made if facilities are limited. It's caused much outcry as disabled children are being labelled as non-treatable under the criteria. It's unthinking legislation brought about by Covid-19 panic.
That is horrid! I know what that sounds like, before I was born. I have a feeling similarish guidelines (laws?) have been drawn up in countries rather closer to us, but I need to be sure of my facts before I spell it out.
I was going to click the heart shaped button to indicate agreement with you, but it seems so inappropriate. But, yes, though I didn’t know that I do know of these kind of things . Are you Icelandic? I am part Scandinavian (the non-asthma part!)
No I'm Irish but live in the UK. But my friend has a DS son and so we now we're more aware of what's going on around the world in respect of disabilities and legalised discrimination. She lives in the States and is campaigning against the current legal changes that would deny her child treatment.
I'm not in the least surprised by the DNR phone calls but we should not accept anything we don't agree with. I would be upset to receive such a call but hope I would have the nerve to tell them to think about their processes.
Hi there, I am so sorry this has happened to you as I know what a horrible impact it has on you afterwards.
It happened to me when I was admitted to hospital 3 weeks ago.
I was actually still in Majors in A&E and the only thing the doctors wanted to talk to me about was that they planned to intubate me & put me on a ventilator if the swabs were positive-which to be frank is how they appear to have dealt with the vast majority of people in hospital who tested positive for COVID 19.
When I expressed my concern about this as I was still awaiting the testing for COVID-19 and said there had been problems intubating me on previous occasions I later discovered they categorise that as a DNR conversation!! I find it extremely alarming and extremely frightening that this appears to be the way the NHS is currently dealing with the current - and other - health crisis.
I was in the midst of an acute exacerbation of asthma and they were concerned I had COVID because my cough was horrendous.
I am nowhere near 70 so it’s got nothing to do with a particular age group - it seems to be like this is the new policy, which should be alarming to all of us.
Hi I'm sorry you were asked this. I'm appalled. If you are in ICU and desperately poorly surely a telephone call to a family would be better to discuss this. I have been asked about DNR for three relatives in the past and its awful. I suppose they have given you a choice but think it's very cruel at this time and makes you feel like you not worth saving and wonder if you are going to be left. I would say no!!! If you get in a crisis surely a conversation with a loved one is better than asking you.
I agree it’s insensitive to be ringing round asking the question out of the blue. The answer in your case sounds like - thanks, but I’m still very attached to my life, so do what you can. Even if you did choose no aggressive methods, tho, they will still treat you, even in this crisis.
My 87 yr old uncle was admitted with pneumonia, ? Covid19 a couple of weeks ago. He was asked, and said no aggressive methods; the hospital then called his wife and daughter to check they agreed. The Covid19 tests came back negative (twice), but he developed sepsis. They didn’t give up on him (even tho he went very cantankerous and non-cooperative for a while), and he is now at home (after a third test, just to be sure) - last heard of carpet-sweeping the living room, and objecting to having a carer (he’s already cut three daily visits to one, and is aiming to get shot of that). He’s certainly not been written off because of his age.
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just need to offload!
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