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Delicate post. DNR.

VickyG

Registered User
Feb 6, 2013
327
Birmingham
It's a bit of a delicate one, and I'd hate to upset anyone on here with it... but I have a question around DNR - do not resuscitate.
How did people go about it?
How do you feel about it?
I ask as I know CPR is extremely physical and Mum managed to crack her ribs again just closing her curtains. We are no way near end of life but I was just wondering, do we or don't we.
Thanks. SR
Good afternoon SugarRay,

DNAR as it been known for some time, is a delicate subject. They are there in my opinion, to be used when only appropriate and in no circumstances, lightly. You can speak with the GP, they will issue a DNAR form, but, in my experience ( professionally and personally ) it's certainly not something, if they are any good, that they will just happily write out for you.
It has to be for the right reasons, any underlying medical conditions, expected recovery and more importantly, QUALITY of LIFE is taken or should be taken in to consideration. Whilst I am no medical expert, I do have enough experience to understand that once a person is starved of oxygen, brain damage is a real possibility and that, coupled with Dementia, can only have a negative impact. That along with the obvious breaking of ribs and possible damage to other organs etc
I hope you haven't found what I have written to be offensive in any way, I know folk have their own opinions, and quite rightly so. Like I say, I do have personal as well as professional experience of the subject, and MY opinion is : DNAR is appropriate if it's appropriate for the person who's name is going on it.
Take care,
Vicky
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
We said absolutely not for our mother some time ago. She is now 96 with advanced AD, and has not been enjoying life or having any fun for so long now.

Of course so much will depend on the stage someone is at, and whether they are happy or are still getting any pleasure out of life. But personally I think it would be positively cruel to actively try to prolong the life of anyone like my mother, if Nature were trying to let her go.

I am probably also influenced by a neighbour, then in his 80s, no dementia, who was given CPR. He said the after effects were so painful, he wished they had allowed him to die. In fact he did not live for many months afterwards.
 

WelshTiger

Registered User
Jan 25, 2015
1
Denbighshire
Originally had this discussion with my mother and her GP when she was 1st diagnosed with Vascular Dementia a few years, she was 73 at the time and she chose to have a DNR put in place, but the GP never put it on paper.

She is 77 now and in the later stages and I am her sole carer 24/7. She suffered quite a large TIA yesterday afternoon, so we had the same discussion again yesterday with a different GP and the GP needed her to tell him herself that she wanted a DNR in place and no hospitalisation.
 

wobbly

Registered User
Feb 14, 2012
313
Mid Wales
We have sorted DNR for my Dad, he is probably at an advanced stage but still mobile, doesn't know any of us, can be agitated, sad and everything else that goes with all this, we did not want him to be brought back to more of the same really. He watched his Mum and two brothers go through dementia and always said we wouldn't have to worry about him because he'd be at the bottom of the Severn, and swore he meant it, I often think if he had had more insight earlier on he would have been too. The home have been through end of life care with us the family and we have supplied answers that we know Dad would agree with, we don't want him rushed to hospital with a stroke or the like we want him cared for in the home, hospital is fair enough if it was something like a broken hip where he would be in horrendous pain with or the like.....we had a good chat with his old GP and now that he has moved to the emi nursing home the new GP agrees to carry on thinking the same. He is so well cared for at the home dom't get me wrong but we just don't want to proplong his life when it it how it is at the moment :( I really agree with the idea of being there on my own with Dad if he was not as advanced with it and doing cpr, it would be so hard to see him suffer so would not judge or disagree with anyone's choice to perform it even if they knew it would not necessarily help...who knows what goes through your head till you are in that situation.....
 

Soobee

Registered User
Aug 22, 2009
2,733
South
I have no problem with DNR per se. But I do wonder how CPR can be quite so useless, brutal and damaging to the ribs when it is taught to schoolchildren, and almost anyone is praised for trying it on people whose condition they know little about. Is this particular argument being 'oversold' perhaps?
It is taught as first aid because the assumption is made that if anyone has a heart attack they would want to be treated for it. It is brutal but for a younger or fitter person it is certainly recoverable and the chances of survival are far, far greater. They went through the odds with my dad when he wanted it on file. Although he had advanced lymphoma they would have attempted resuscitation if he hadn't done the DNAR form.

I am now in a quandry - I'm not sure I would want to give CPR to a man on the street because I don't know if they want it or not. I would be gutted to intervene for someone who didn't want it. I have avoided refreshing my first aid training for this very reason.
 

Saffie

Registered User
Mar 26, 2011
22,514
Near Southampton
I am now in a quandry - I'm not sure I would want to give CPR to a man on the street because I don't know if they want it or not. I would be gutted to intervene for someone who didn't want it
I think that the person in the street could be presumed to be in reasonable health and not lying in a hospital or a nursing home with a limited lifespan and such a low quality of life that not to attempt to resuscitate would be appropriate.
I would err on that side anyway without anything else to go on.

I did the full, but squashed into days rather than weeks, basic Hampshire Ambulance training some years ago, when I was working as a medical librarian in our county hospital and I'm sure that there are many people who have been given CPR without the resulting traumas that are being reported here.
It is a case of being aware of the possible consequences for people who are already in very poor health and for whom the results of CPR may not give them the quality of life they had previously if their brain is starved of oxygen for an amount of time.

My husband was resuscitated in the hospital a week after his amputation. He had been left sitting in a chair for the first time and the staff thought he was asleep but he had stopped breathing. I was sent for and it was a frightening scenario that greeted me when I arrived at his bedside with about 6 medical people around it.

That evening was the first time I was asked if it happened again, did I want my husband to be resuscitated and I was so shocked I couldn't reply. In fact, his kidney disease meant that his kidneys were not excreting the morphine from his body as they should and he had OD'd on morphine, so the question wasn't really appropriate.
He broke no ribs though and although the trauma of the amputation and the morphine itself probably contributed to his increased dementia, I have no proof that his resuscitation did. No proof that it didn't either of course.

Do I ask her GP?
Piph, yes, I would ask his GP. They do keep DNRs or 'purple form' as they call them with medical records in a practice.
 
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SugarRay

Registered User
May 5, 2014
48
Sunny South East
Good afternoon SugarRay,

DNAR as it been known for some time, is a delicate subject. They are there in my opinion, to be used when only appropriate and in no circumstances, lightly. You can speak with the GP, they will issue a DNAR form, but, in my experience ( professionally and personally ) it's certainly not something, if they are any good, that they will just happily write out for you.
It has to be for the right reasons, any underlying medical conditions, expected recovery and more importantly, QUALITY of LIFE is taken or should be taken in to consideration. Whilst I am no medical expert, I do have enough experience to understand that once a person is starved of oxygen, brain damage is a real possibility and that, coupled with Dementia, can only have a negative impact. That along with the obvious breaking of ribs and possible damage to other organs etc
I hope you haven't found what I have written to be offensive in any way, I know folk have their own opinions, and quite rightly so. Like I say, I do have personal as well as professional experience of the subject, and MY opinion is : DNAR is appropriate if it's appropriate for the person who's name is going on it.
Take care,
Vicky
Vicky, not offensive in anyway and thank you for your post. These forums are an excellent way to gather information and then mull it over - which we are - lots of mulling going on!:) Thank you SR
 
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SugarRay

Registered User
May 5, 2014
48
Sunny South East
It is taught as first aid because the assumption is made that if anyone has a heart attack they would want to be treated for it. It is brutal but for a younger or fitter person it is certainly recoverable and the chances of survival are far, far greater. They went through the odds with my dad when he wanted it on file. Although he had advanced lymphoma they would have attempted resuscitation if he hadn't done the DNAR form.

I am now in a quandry - I'm not sure I would want to give CPR to a man on the street because I don't know if they want it or not. I would be gutted to intervene for someone who didn't want it. I have avoided refreshing my first aid training for this very reason.
If I collapsed In the street I would love and hope someone would leap up and down on my chest. That's me and please don't let it put you off doing it for someone else. I'm only talking about the one person and trying to gather information on this forum to have an intelligent conversation with the family and cover all options - like I've said a great deal of mulling going on here. SR
 

nicoise

Registered User
Jun 29, 2010
1,806
My mum worked as a nurse, and had very clear views and personal opinions about living with challenges as a result of disease or accident. When she was diagnosed with Parkinson's she made it very clear what her feelings were about the possibility of losing all her physical abilities, and living like that horrified her.

So I was in no doubt about what she would have felt about a DNAR note in her file once she was diagnosed with dementia - she would have been totally in favour of it.

As it came about, when we ultimately got to that point, she was in a very poor state both physically and mentally. Interestingly, the bigger challenge I had was convincing the medics that I understood the implications of DNAR, and that I had no doubt my mum would have agreed had she been able to speak for herself. This was just after the LCP outcry, so perhaps they were a little more sensitive about the whole issue of end of life care.

Each to their own of course, but for me it was an easy decision as it was my mum' s often stated choice, not one I was making with no input or knowledge of her feelings. And even though I didn't want to lose her, I couldn't go against her wishes for herself.

CPR was never necessary for her - I wonder how often it really does happen in reality? - but discontinuance of medications after yet another bout of aspiration pneumonia was the final outcome - again, knowing her feelings gave us guidance along with the medics.
 

Belleooo

Registered User
Dec 2, 2014
6
Aberdeenshire, Soctland
Placing DNR without informing care giver

Hi, yes its a very difficult topic and everyone's circumstances are different and should be treated on an individual basis. I am not against DNRs at all and think they can be very useful. However my experiences concerning the DNR placed on my Dad during a hospital visit in November was not a good one. Dad was admitted because he couldn't move. Turned out to be a bowel blockage. Dad had had several diagnosis placed on him. Most obvious to us Dementia with Lewy bodies, Heart disease, and they were suspecting bowel cancer, hence blockage. Though he was too fragile to carry out a full investigation. Anyway we were speaking to the Doctors one day and he casually mentioned the DNR which he had placed on my Dad without any of our consents and knowledge. You know just slap an important document like this on a person without informing his next of kin/carer. And the withdrawal of his medication. I was furious. In better times Dad told me his mainly heart meds kept him alive. Dammit I knew my Dad better than these guys. And knew it wasn't time to withdraw his meds. Basically I fought to get the meds reinstated and Dad recovered pretty well. Came home and spent two very happy pain free months with us. All along this evil specter of DNR hanging over him. The night we lost him, heart attack, we didn't hesitate to try CPR on him. Or stop the Paramedics from trying. We weren't ready to let go, DNR document was the last thing on our minds. I don't know understand why, probably the urgency of what was happening. Maybe it should have been explained better to us? That day he had enjoyed a good day, small walks, ate family meals. We weren't talking about a man clinging onto life. I have seen many times terminally ill patients, I felt Dad didn't fall into that category at that time. When I come across that evil document I am placing it in the stove and burning it. I would have thought tooth and nail for Dads right. He loved life, he wasn't suffering any pain, his alzheimers robbed him of knowledge to understand how grey his prognosis was. Sorry for this raw response, its still very painful. Guess time will heal.
 
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SugarRay

Registered User
May 5, 2014
48
Sunny South East
Hi, yes its a very difficult topic and everyone's circumstances are different and should be treated on an individual basis. I am not against DNRs at all and think they can be very useful. However my experiences concerning the DNR placed on my Dad during a hospital visit in November was not a good one. Dad was admitted because he couldn't move. Turned out to be a bowel blockage. Dad had had several diagnosis placed on him. Most obvious to us Dementia with Lewy bodies, Heart disease, and they were suspecting bowel cancer, hence blockage. Though he was too fragile to carry out a full investigation. Anyway we were speaking to the Doctors one day and he casually mentioned the DNR which he had placed on my Dad without any of our consents and knowledge. You know just slap an important document like this on a person without informing his next of kin/carer. And the withdrawal of his medication. I was furious. In better times Dad told me his mainly heart meds kept him alive. Dammit I knew my Dad better than these guys. And knew it wasn't time to withdraw his meds. Basically I fought to get the meds reinstated and Dad recovered pretty well. Came home and spent two very happy pain free months with us. All along this evil specter of DNR hanging over him. The night we lost him, heart attack, we didn't hesitate to try CPR on him. Or stop the Paramedics from trying. We weren't ready to let go, DNR document was the last thing on our minds. I don't know understand why, probably the urgency of what was happening. Maybe it should have been explained better to us? That day he had enjoyed a good day, small walks, ate family meals. We weren't talking about a man clinging onto life. I have seen many times terminally ill patients, I felt Dad didn't fall into that category at that time. When I come across that evil document I am placing it in the stove and burning it. I would have thought tooth and nail for Dads right. He loved life, he wasn't suffering any pain, his alzheimers robbed him of knowledge to understand how grey his prognosis was. Sorry for this raw response, its still very painful. Guess time will heal.
Hi, now that is an aspect I hadn't considered and yes I'd be furious with it - it's one thing the family trying to do the right thing and even talking about the subject in the first place , but to have it forced by someone else is a horrible thought. I'm so sorry. SR
 

SugarRay

Registered User
May 5, 2014
48
Sunny South East
Update

Bit of an update - a nominated nurse visited Mum and the other residents in the care home on behalf all of the town's GP surgeries. Apparently a new DoH initiative to talk about what needs the patient wants in the future.. DNAR, where to die etc...

I wasn't present at this meeting but the head of care was. Mum was undecided about the DNAR at that time.(Fine by the family). I was told that a GP, again on behalf of all the GP surgeries would attend to speak with all the residents in a couple of weeks. I did ask if I could attend that meeting....

I get a call from the home one morning to say the GP was there, they had forgotten to let me know (glad I wasn't there really) and Mum had decided herself for a DNAR. But wanted the head of care to call me first so I could give her decision my blessing. Which I did.. and then promptly burst into tears after I'd finished the call.

So there we now are. Mum decided herself. Everything she wants is now in place (bar any unexpected occurrences).

Thanks for all your input and answers it's been most useful - and hopefully useful to others that may read this post in the future.

SR.
 

Canadian Joanne

Volunteer Moderator
Apr 8, 2005
16,643
66
Toronto, Canada
It must be such a relief for you that your mother decided this for herself. I'm glad for you.

My mother was not able to make that decision, but since we had heard her say many times when she was well that she didn't want to live on machines, my sister and I feel we're simply following out her wishes. BTW, mum is still very much with us, albeit in the last stages of AD.
 
I'd heard that for anyone over 75, and anyone with dementia, Resuscitation was likely to lead to a much poorer quality of life thereafter - a real step downwards. With both factors, double trouble. Mother was 97, living with dementia, quite contented and enjoying life but sometimes wearily saying "oh it's dreadful being old". I was quite happy to agree to DNR, and had another conversation about it with the consultant when she went into hospital at the end with what turned out to have been a "silent heart attack" a fortnight earlier, which had caused her no problems until the morning before she died, when she was a bit poorly and feverish and ended up going into hospital that evening. She died, very peacefully, after just the one night in hospital, with me beside her; we were both very lucky.

I'd always hoped that something swift and painless would happen to her before the dementia progressed so that either she had to move away from her lovely care home (gorgeous gardens and views, coping with mostly confused residents, but not dementia specialised) or she lost her pleasure in life (views, garden, repetitive conversations, TV as long as it didn't have a plot, etc).

Everyone is different, but I think you need to think about the likely quality of life after resuscitation and consider whether it is, or isn't, in the interests of the patient to drag them back into what may be a damaged version of life (even more damaged than they already are), and to make it more likely that they'll have a long and distressing future.

Pam
 
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jen54

Registered User
May 20, 2014
240
we had a DNR for dad when he was near the end with cancer, it was to make sure he was cared for at home and not taken to hospital to die, we were told on no account ring for an ambulance , because once they arrived they would be obliged to take dad to hospital, if a DNR wasn't on the premises they have to take the patient., if a DNR was on the premises, ie there was a sticker on our door window saying where it was to be found- then they could leave dad at home, they thought his heart would give out before the cancer took him tbh. and recusitation would serve no purpose but prolong suffering
we were told if we were were worried by any thing re dad's condition,we had to ring the palliative care team, or rennie nurses and they would come immediately and see what was needed, as with dad it was obvious that rushing him to hospital was pointless as he was terminal. It sounded awful when we were first asked, but it was explained in a way that made sense-why have dad taken to hospital where they could do no more anyhow, why not let him slip away at peace, all his needs were taken care of painwise etc at home
 

Greycardi

Registered User
Sep 26, 2015
123
Extremely grateful for this discussion thread

This thread has been very enlightening. Balanced views all represented and many pros and cons being put forward from a perspective of lived experience. Thanks everyone, I could never have got this picture from an official website.
 

Earthgirl72

Registered User
Feb 2, 2016
136
Sorry for what is potentially a stupid question.

My dad was hospitalised back in September, we were advised to have him as DNR. Although I really thought we were going to lose him, he pulled through, and is - touch wood - doing ok at the moment.

My question is, once a patient as been designated DNR, is it rescinded after the spell of whatever that initially triggered it? Or does it just stay in place?

I'm hoping that it's the latter, I know that's what Dad wants, as we discussed it.
 

tryingmybest

Registered User
May 22, 2015
644
A different perspective

My Mum has twice needed an ambulance recently having passed out and been sick, the second time banging her head. On both subsequent visits after these two events, to the doctors, Mums GP asked me if I'd thought about DNR. Each time I promptly burst into tears and refused to discuss it, especially as Mum was with me. I raised it with my Mum on one of her good days and she agreed to it. However I still haven't signed the paperwork as what concerns me is that I've seen evidence many times in the past where people who have one in place have not received any type of medical care because of it.....almost it is used as an excuse for not bothering. That is what concerns me. I wouldnt want Mum to be deprived of any type of help because of this. I know it should only apply to CPR but in practuse, it sadly doesn't.