I apologise should this post awaken memories the question was asked in good faith
BHF I understand this may be controversial but in the current situation is important. Like the Liverpool Pathway was debated and found to be controversial.
I have just had a row with my wife over an article in todays Daily Mail ( I Know ) how does a DNR notice work. Can your GP decide to add a DNR notice to your record without your consent, or even a Hospital Doctor ??
I think why I am asking is do you NEED to give consent for DNR as long as you have Capacity ?? Just the article indicates the Medical Profession can decide for you. That sounds like Selective Euthanasia.
posted in good faith
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My late husband agreed to a DNR when it first arose while he was in one hospital but when he was later in ITU in another hospital it was down to me to agree although it seems in the article by law the Dr has the right to decide.
Far worse is when they want agreement to switch off life support, that really is difficult even when it's the only option, hope I never have to do that again 😕
The doctor Max Pemberton joined in on this debate last week, when he described the pointless use of CPR on the very elderly and administering CPR and listening to ribs breaking knowing that the patient would almost certainly either not survive, or survive with a very poor quality of life (I think he also touched on CPR in his book Trust Me, I'm a (Junior) Doctor saying that CPR is a very brutal process.As someone who has had CPR, while I was (thankfully) unaware of what was going on at the time, I can confirm that is certainly is no fun. I was in extreme pain for a few weeks, and it took about 4 months to feel fully good with no twinges of pain in chest/ribs/back/shoulders.
I was 64 at the time, and it really did take it out of me, God alone knows what it would do to someone in their 80s!
I agree that CPR is almost certainly not the answer as you get older and your medical problems mount up and to that end a patient voluntarily having something in place to make clear what their wishes are in various situations is a preferred option - while I'm hoping not to be going anywhere for quite a while, it's something I'm working on while I'm well enough to be able to make these decisions
This is a tricky one. Im still reeling from memories relating to my husband. He had a number of DNR forms done but the consultants and g.p. felt he shouldn't be as well as me. His pacemaker was running out, he had cancer somewhere, multiorgan failure and dementia but still insisted on being resuscitated so in the end the g.p. and I had to destroy all the older forms and complete a new one in his presence but without elaborating anything. He passed away peacefully, without pain in his bed at home looking contented. If he had been allowed to keep the other forms he would have been rushed into hospital for emergency treatment because he had a defibrillator. What we did was the right thing for him and for me.
Sorry to hear of your loss but glad to hear hubby had a dignified and peaceful passing xx
For the benefit of conversation let's take DNR out of the equation.
When you are admitted to A&E following some severe car crash or other accident that has caused severe injury, or if you've agreed to undertake life saving surgery - the clinicians (Doctors, Surgeons etc) have always had the ability to say "we tried our best but no more can be done so let's mange their end of life".
No DNR required, asked for or offered - for me, DNR is your way of saying under what conditions you would not wish to be revivied in the event of things going badly wrong with your health.
I was unable to complete a DNR for my heart surgery - but my wife and daughters knew under what conditions I would not want to be revivied - or stabilised as the surgeons put it.
Oddly enough you cannot complete a DNR if you suffer from Depression/ Anxiety either.
Anyway, that's my take on DNR's - hope it gives another take on the argument
Being a lady of a certain age I know several people up here in Scotland of a similar (or greater) age who have discovered to their shock and dismay their medics have put a DNR on their records - without discussing the placement with them. A few of my friends have been relentlessly pressured by their medic to sign an agreement to DNR placement.
When a patient asks to read his/her records and is told no, the answer usually lies in the presence of an unknown DNR these days, especially with older patients with complex medical conditions.
One of my neighbours is a youngish (late 40s) man with MD (Muscular Dystrophy) and he's living independently rather well considering his condition. And just before lockdown he dared look over the doctor's shoulder at his notes on-screen - big bold letters DNR. A DNR he never agreed to nor would he as he feels he has many years of Life left to him despite the MD.
Needless to say a discussion should be made before any DNR put on someone's chart. There are reasons (euthanasia, Liverpool Pathway...) it should be a patient-medic decision or a family-medic decision, not an arbitrary decision taken stealthily by a medic with a God Complex.
My late husband was a surgeon who spent most of his career seconded to the US and Latin America and a large part of why he did that is owing to not wanting to be pressured to DNR patients. Medics ARE pressured to put those DNRs on patients without discussion and from what I heard my late lad and his colleagues say, it's usually money-based.
That said, it is also true there comes a time for a DNR - CPR is catastrophic for patients with osteoporosis, for starters, and mechanical life support rarely sees a patient come back. There are exceptions and why 'pulling the plug' should be very carefully considered, very very carefully!
My father (COPD, CHF) had a DNR as did my late husband - but both made that decision on their own after long discussions with their attending. Both gentlemen died in the USA where a DNR is a patient/family-medic decision.
It's the quiet scandal up here in Scotland and from what I'm reading across English and other home nation news, it's happening there as well. Placing a DNR should be legally restricted to a patient-family-medic decision. The 'power' to place a DNR should never be in the hands of the medic only (or on the orders of 'management').
I read your earlier post (about a catastrophic event like a car wreck) and found it interesting.
My late husband would come home after hours of working in theatre to save someone's life only to see them unable to be saved - no DNR needed in those instances - and he was always shredded when it happened. In cases of 'last hope' surgeries he always made sure to talk with the patient or her/his family in order to understand their feeling on life-support, outcomes, and always made sure those feelings and the discussion(s) had were noted.
Very very rarely he would have a patient or family say they wanted the patient kept on life-support even if the outcome was hopeless but he always respected the will of the patient and family - and management stayed out of it.
Usually after discussion the DNR would go in place owing to prognosis and everyone was satisfied everything possible had been organised. Although saddened when life-support or resuscitation was not started or if implemented was eventually was withdrawn, making sure everyone from patient to loved ones to medics knew best efforts happened made it slightly less harrowing when the time came to give up the fight.
I did some volunteer work at end-of-life events and believe me, the turning off of life-support is truly harrowing for everyone including the medical teams and support volunteers - but knowing what is going on makes it a wee bit easier on the loved ones. A stealth DNR takes that grief-easing away from the loved ones and that should be criminal.
Having been the recent recipient of '3 weeks of stabilisation' (as it was called) following my surgery - i am well aware of how stressful it must be on all the staff involved. My wife and daughter had to attend me to say goodbye on at least one occasion (my daughters view of me "a corpse attached to a mass of machines via tubes and cables) does not bare thinking about.
I feel very much for you and your husband for the work you have done/ do and you have my thanks on behalf of all who undertake such roles.
When my mum had a stroke and was unconscious my sister and I were asked if we would consider having DNR on her notes as there was not much chance of recovery or if she regained consciousness you would probably be severely brain damaged. We both agreed the DNR but a few days later mum regained consciousness and we asked for the DNR to be removed it was refused. I ended up telling the hospital that I wanted my mum to go to her local hospital if she was dying as they were not feeding her and would not insert a drip. She was moved the next day and I was at the hospital when they bought her in saw a doctor and he immediately took bloods and in less than an hour a drop was inserted and a few hours later fully conscious. Although she was not the mum we knew she was later discharged to a nursing home and survive another 4 months so please think carefully about signing a DNR
I had spoken with my late father about how he wanted his life to end.
He was very clear no extraordinary means please no CPR. He was in his late 60's at the time.
Aged 72 he had a massive heart attack he didn't regain consciousness. We knew his wishes so when we were asked by the medics as a family we could say no to CPR being performed.
He died peacefully 24 hours later in hospital.
A DNR order does not mean that any other care is withdrawn. It just means that if a person's heart stops or their breathing stops that Cardiopulmonary resuscitation CPR is not performed.
As SpiritoftheFloyd described CPR can be brutal.
The discredited Liverpool Pathway of withholding fluids including IV fluids thank goodness has now been dropped.
I do believe the medical profession do make assumptions about someone's worth as regards saving. Thankfully not all of them do. Maybe sometimes they are right, but that doesn't make it acceptable. I personally have been on the end of this when they advised putting my dad on the Liverpool Pathway, thankfully this form of murder has now been banned. But DNR does still exist. If we do not legalise people asking to be helped to die, than DNR should be banned also.
Death is still a taboo topic for a huge number of people. Look at the stats for the percentage of the population who don't have life insurance and haven't bothered to make a will. I have had discussions with my wife and adult sons about my death and what for me are the conditions that would constitute being alive but not being able to live a life that I would consider worthwhile.
Hi I definitely want DNR I have no idea if it is on my notes or not I have osteoporosis and I don't think my body could take cpr, I just think when my time is up its up and that's that, to be honest with the state my old heart was in and living with it so long I am surprised and I think the doctors were as well that I actually made it to transplant, second chance has been given and I am so grateful for that, I couldn't get life insurance but I have a will and left instructions for my boys, I just hope they follow them! Char
I'm in the US. Do you have living wills or something we call Heath care proxy? A proxy is the person that knows your wishes and will be the one to make end of life decisions based on discussion you have had together.
I'm a nurse. DNR is not put on a chart without family discussion and needs to be addressed every hospital admission. It is suspended in the operating room. No one is a DNR in the operating room. Once the surgery is over the DNR will be reinstated.
Yes both myself and husband have a living will. Though after signing was told our next - of kin - can over ride if they feel it’s wrong have informed our sons and they have copies so are well aware what we want.
Actually, the real final gift after a living will is a pre-planned and paid funeral and interment. My dad died 21st December 1985 and to this day my brothers and I still say that was the greatest gift our father gave us. Everything was organised the way he wanted it (as it should be no matter what the loved ones want) down to the hymns, the only 'change' we made was the addition of a piper.
As for the DNR he wanted, the reason for it was his osteoporosis. The DNR was a good thing for him and for us (took all the 'should we/shouldn't we' out of the frame) but really the greatest final gift was the pre-planned and paid funeral.
That's true on the arrangements. I'm glad that was done for you. I'm cleaning out my house. I feel that's a gift to those I leave behind. Going through a whole lifetime of stuff is exhausting. I did also write my obituary. I know me better than anyone else. I know what I want in there.
I was more referring a gift we can give the person that is passing.
Oops, sorry! I misunderstood that (gift to the person, not the loved ones). I think you're spot on about that gift now I understand what you meant - both Dad and my husband seemed so relieved when we promised to follow their wishes. I think it made their final days easier knowing we were going to do that.
Thank-you for clarifying and I apologise for missing the intent.
That's ok. Talking about the gift to who you leave behind is important too. If we've been through it, we know what we would have wished had been taken care of.
These conversations are so important to have. I'm really glad to see it being discussed.
Hello. First of all, a warning. I’m afraid this is a bit of a long story and it’s upsetting but my intention is to inform via true experience. There’s a sad ending.
My 91 year old mum passed away just 3 weeks ago from sudden and unexpected cardiorespiratory arrest. She had AF and was having dizzy spells for which she was prescribed Iron as her levels were low. Then over a period of a 4 weeks or so her GP took her off her ARB Candesartan, halved her Bisoprolol and then after an ECG about 3 weeks later taken off her Bisoprolol, leaving her just on her anticoagulant Apixaban. Her ECG showed “marked sinus bradycardia with 1st degree AV block and left bundle branch block”. He said to come back the following week for another ECG then possibly be referred for a pacemaker.
At no point was there an indication that she was at risk of anything untoward happening. And certainly no DNR or discussion about one.
A few days later, she felt unwell and wondered about phoning her GP. I called the GP for her and on the advice of the duty GP who called her back a couple of hours later she phoned 999. They said a Dr would call her within an hour. She text me and my sister to let us know and my sister left work, finding her about 30 minutes later collapsed on the floor and unconscious. The paramedics arrived in 2 minutes and thought it might be neurological, possibly a stroke.
In A&E, a brain scan showed it wasn’t a stroke so a scan of chest and abdomen was arranged. Whilst she was having the first scan, the doctor asked my sister if there was a DNR, which there wasn’t and which we knew my mum didn’t want as apart from this dizziness issue she had a good quality, independent, active, still driving her car safely, facetiming, life. The doctor asked again before mum went for the second scan. She explained they would usually only do resuscitation when there was a known cause of the arrest and they could do something to fix it.
Sadly, she arrested on the way back to A&E after the scan and they couldn’t resuscitate her.
My point being, that the A&E doctor was telling us that unless they could fix the cause of any arrest, resuscitation was pointless as it would keep happening. So, DNR or not, there needs to be a way forward for preventing the cause of cardiac arrest repeating because the patient will pass away anyway. And it would be very distressing.
As it turned out, the second scan didn’t reveal the cause of the problem either and we’re awaiting further analysis of tissues taken during autopsy to try to establish the cause of the arrest.
I hope I haven’t caused too much upset with my reply, I want to show that in reality the question of resuscitate or not isn’t straightforward.
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