Consultant has decided to put a DNR order on my Dad

[sparky023]

How can he do this? Don't we get a say? Yes, Dad has vascular dementia, but only diagnosed 4 days ago! Dad is currently on dialysis (started 10 days ago) and with his improvement of mental state, he's looking forward to being discharged next week (whether that be into a care home, or to his house, with a care package in place) and have outpatient dialysis 3 times a week. He can still have a good quality of life, he can see his eldest daughter turn 40 in the summer, he can see his younger daughter get married and start a family, he can still be a husband to his wife.

If this was an end of life decision, if he was just talking about if and when dialysis treatment is withdrawn and death for my Dad is inevitable then I'd understand this. But no, the consultant said for all the time Dad is under his care, in that hospital ward, if for any reason, his heart stops, they won't resuscitate.

Xx

 

[Wigan]

It's terrible. Last year when mum was in A&E with pneumonia, a grim looking registrar was eyeing up patients in cubicles and decided to come to me after my sister had left and asked for a word. He asked if we had thought about a DNR, I replied no we hadn't. He went into graphic detail of what they would do if mum needed to be resuscitated and said he wouldn't put his own mother through it. When I said it needs to be discussed with family and not a decision I could or would make on my own, he said I will make it easier for you and put a DNR on your mum.

I was upset and furious so went to the nurses station where he was sat. I asked who he was and said I didn't agree with what he had just done. I then asked if he thought mum was going to die, to which he replied "no I don't" and went on to say the DNR was only valid for this stay in hospital anyway. I asked what it was all about then to which he replied, I will tear it up, and he did.

I don't believe anyone can just place a DNR on someone without discussing it first with family. The family can object and the consultant should listen to the family and talk all the options and likelihoods through and, respect their wishes. I was told I could have reported this registrar but as the DNR was torn up, I had no proof.

I think most people would agree that if someone has little quality of life and they are likely to pass away, then it would seem cruel to put them through the traumatic ordeal of resuscitation but, if there is hope and some quality of life then it is not acceptable for a consultant to suggest this.

Speak to him again and express your concerns.

 

[Amy in the US]

Sparky, you are right, this is not acceptable. Clearly there has not been good communication with that consultant and I agree you need to get this worked out.

Please forgive me if I get the terms wrong (as I'm not in the UK), but you need to talk to someone at the hospital about this. Perhaps a social worker, the PALS team, a patient advocate or ombudsman, the ward manager/nurse manager/matron, even the chaplain if you can't find anyone else, but DO be persistent and DON'T take no for an answer.

I am so sorry and cannot imagine how you must feel.

 

[CeliaThePoet]

I definitely agree that communication is lacking.

In the US, a doctor cannot and usually will not apply a DNR without the person/health care proxy requesting it. I understand that in the UK, this is a choice which can fall under the doctor's purview only, but I don't know the guidelines around it; please forgive what I have to say ahead.

Thinking aloud, I think perhaps the doctor sees a frail person, knows that resuscitation means the breaking of ribs, possibly internal organ damage, resulting surgery....many elderly people do not recover from the battering which is resuscitation. Also, bringing someone back to life after they have died can mean the person has permanent brain damage from lack of oxygen. DNR does not mean anyone is at end of life or that they won't care for your dad in every other way. In a way, it is care, though I understand it is hard to see it that way when you are first faced with it.

It is still up to you to express your father's wishes, but try to see that the doctors have likely seen awful results, too, and are trying to spare your dad this.

 

[garnuft]

I think the thing to remember is its when the heart stops. It's about attempting to restart a heart.

DNAR to me was not about ignoring health and welfare, simply about restarting a heart that has stopped beating.
In some circumstances it's not appropriate but Amy is right, communication is the key and the Consultant has no ability or legal standing to pass down such a diktat.

You need to talk to the Consultant and he needs further training.

You can and must always challenge such fundamental issues as this.

That doesn't mean with more discussion you won't agree it's the right way, but you need the discussion.


Sent from my iPhone using Talking Point

 

[canary]

That decision should have been discussed with you.


Having said that I would like to point out that CPR is not like it is portrayed on Casualty or Holby City - it is quite a brutal process, often resulting in broken ribs and if there are other health problems frequently doesnt work. Having a DNR also doesnt mean that they are in end of life stage - mum has one and she is not end stage dementia. I agreed to a DNR for her because I dont think think that she would want to be brought back and to die because your heart stops beating is IMO a good way to go, although I understand that not everyone feels the same way about this.
You need to have that discussion with the consultant.

 

[Belizzie]

DNAR. The medical profession are supposed to discuss this with the next of kin!!

How can he do this? Don't we get a say? Yes, Dad has vascular dementia, but only diagnosed 4 days ago! Dad is currently on dialysis (started 10 days ago) and with his improvement of mental state, he's looking forward to being discharged next week (whether that be into a care home, or to his house, with a care package in place) and have outpatient dialysis 3 times a week. He can still have a good quality of life, he can see his eldest daughter turn 40 in the summer, he can see his younger daughter get married and start a family, he can still be a husband to his wife.

If this was an end of life decision, if he was just talking about if and when dialysis treatment is withdrawn and death for my Dad is inevitable then I'd understand this. But no, the consultant said for all the time Dad is under his care, in that hospital ward, if for any reason, his heart stops, they won't resuscitate.

Xx

 

[notsogooddtr]

According to the GMC there should be a discussion with the patient and if appropriate the family but the final decision is down to the doctor.Patients should be offered a second opinion.This has been tested in the courts.