1. MrsTerryN

    MrsTerryN Registered User

    Dec 17, 2012
    Mum is near end stage dementia. There is a dnr in place. Mum is currently quite unwell with the flu.
    I am waiting on the next step if there is an infection with this flu.
    Do I go down the path of antibiotics if pneumonia is diagnosed?
    At what point does the no heroic measures come into its own ?
    I will check the dnr instructions but I just wondering what others did?
  2. marionq

    marionq Registered User

    Apr 24, 2013
    This will be your call I think. I know what I would do to get released from this illness. Good wishes to you.
  3. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    North East England
    We decided, in my late Mum's case, that oral antibiotics were acceptable to try, IV ones were not. She was to stay at her CH which was residential not Nursing, therefore IV would have meant taking her to hospital and she was too frail.
    Heroic measures such as CPR were not to be tried as, again, she was too weak and ribs can be easily broken.
  4. Blogg

    Blogg Registered User

    Jul 24, 2014
    My Dad had an advanced directive that stated no IV antibiotics. In hospital he was given oral antibiotics against ours and his wishes (they said he had capacity, he didn't !) in the nursing home the on call GP and his own GP agreed when we stated we didn't want oral antibiotics, Dad had had enough.

    It's about weighing about quality off life over quantity of life. Thinking of you at this tough time.
  5. LYN T

    LYN T Registered User

    Aug 30, 2012
    Brixham Devon
    I made the same decision as Maureen.

    It's very difficult but try to make the decision based on what your Mum would have wished for if she was well.

    I do feel for you-life isn't easy at times.


    Lyn T XX
  6. nellbelles

    nellbelles Volunteer Host

    Nov 6, 2008
    The CH's Doctor was very good, minor infections would be treated but nothing invasive.

    A very difficult call for you to make.
    Helen x
  7. MrsTerryN

    MrsTerryN Registered User

    Dec 17, 2012
    Thank you. Mum didn't want to be 'reduced ' by this disease as her mother had been. She was most emphatic on that point .
    If she does end up more unwell and they recommend antibiotics I don't know if I could agree to them. I will be speaking to the nursing home tomorrow to discuss what measures they would do.
    I had kinda expected more black and white decisions but thus isn't clear cut
  8. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    We accepted antibiotics as long as they were effective and relieved discomfort. Once they stopped working, we stopped the antibiotics.

    As long as your mum is comfortable she can be left in peace. Any sign of discomfort needs pain relief.
  9. Spamar

    Spamar Registered User

    Oct 5, 2013
    The first chest infection I allowed antibiotics and he recovered. Two months later he had deteriorated a lot. Gp was called. Against my express wishes I was not present. On his death certificate 'chest infection' + old age! dementia secondary cause.

    The good thing is in no way can I blame myself for not allowing ABs. The bad thing is I wasn't consulted. To be fair, he never appeared to have an infection, though I didn't listen to his chest ( not that I would know what I was listening to,)
    But he was ready to go, not eating or drinking, unable to walk or talk much. He hated it, I know that, so I must regard it as a blessing, though maybe in disguise.

    I didn't have the will to challenge things after he had died. I didn't ask what the gp said, but they didn't tell me either.
  10. Saffie

    Saffie Registered User

    Mar 26, 2011
    Near Southampton
    DNR doesn't mean no treatment at all, just no resuscitation.
    When my husband entered a nursing home, it was agreed that he would remain in the home and not sent to hospital unless something happened like a broken arm. ABs would be given but nothing invasive.
    As it happens he only went once apart from outpatient appointments and that was when he had a sudden severe seizure. However, if he'd had a further one, he would have been able to be treated in the home.

    He would have been very uncomfortable and in pain if he hadn't been given ABs when he needed them. That is just fulfilling a duty of care. His other medication was continued too.

    The DNR is not to hasten death but not to go beyond the bounds of logic and compassion to prolong it when the procedure would very likely make someone's already deteriorated life much worse, if it even succeeded.

    The GP automatically prescibed ABs when it was necessary and the nurse rang to inform me each time but I was never asked for my approval or otherwise.
    I couldn't live with myself if I'd ever even suggested she didn't do so and it never crossed my mind.
  11. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    Perhaps if you know exactly what treatments are being/might be proposed, and what they involve, it might give you better information with which to make a decision. As you say, while some decisions might be clear-cut and less difficult to make (for example, saying no to resuscitation, or a complicated and dangerous operation), many are much more challenging: antibiotics? IV placement?

    It's so upsetting and difficult to have to make decisions for those who cannot. However, I think that most of us, most of the time, are able (with the right information and perhaps some empathetic/helpful medical professionals) to make the best possible decision for that person, keeping in mind what is best for them, not us, and what they would want. I think everyone would agree on pain management, so perhaps you can start your conversation with the medical staff there.

    It is never easy and I am so sorry you are having to deal with this.
  12. MrsTerryN

    MrsTerryN Registered User

    Dec 17, 2012
    Thank you every one for your advice . The oral antibiotics versus iv is a great suggestion. Mum is slowly recovering. It was thought provoking to consider the DNR in reality

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