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Doctor asking for DNR decision

Bettusboo

Registered User
Aug 30, 2020
18
When I have contacted my fathers doctor about my concerns about his possible dementia, the doctor has twice asked me to discuss the issue of a DNR with my father. We have lots of difficult conversations to face and this isn’t high on my list of priorities. It seems to be right up there for the GP. Has anyone else experienced this and what have they done ?
 

Grannie G

Volunteer Moderator
Apr 3, 2006
72,142
Kent
It does seem a bit early for this kind of discussion @Bettusboo. It doesn`t seem as if your father even has a formal diagnosis yet.

I was asked this as my husband was entering the final stage of his dementia and all medication had no effect.

I suppose doctors have differing policies but I do understand your upset.
 

canary

Registered User
Feb 25, 2014
13,965
South coast
I was asked about making this decision on OHs behalf when he had a series of very nasty UTIs and sepsis. Fortunately, I had discussed this very issue with him about 6 months previously and was happy to agree, but had I not it would have been tough.

My mum, on the other hand was asked about it by the GP at the time that she was referred to the memory clinic. I think the idea was that she could still make a decision on her own behalf and it wouldnt fall to relatives to make that decision for her.

Whenever this is broached it is difficult to hear, because it pertains to End of Life and we dont want to think about that. I do think it is important to have these sorts of discussions while they still have capacity, though. We know that organising POA and wills is important to do early while they can still do them, but I think that knowing what they would like to happen at end of life is just as important, even if it cant always happen the way they want.
 

Bettusboo

Registered User
Aug 30, 2020
18
He is 89 and has other health issues in addition to possible dementia. With everything else that needs broaching (referral to memory clinic, driving, legal decision making etc etc) and Dad’s difficultly understanding these concepts, it doesn’t seem a priority. I know what I think but not my decision at this point. Seems to be on GPs checklist rather than necessary for my Dad. If it came to it, would the most likely best interests medical decision be DNR or do they have to have it signed off first?
 

Bettusboo

Registered User
Aug 30, 2020
18
We are finding all these discussions near impossible as it is. Won’t entertain POA. Makes it very difficult.
 

canary

Registered User
Feb 25, 2014
13,965
South coast
If it came to it, would the most likely best interests medical decision be DNR or do they have to have it signed off first?
If he is hospital and there is no DNR, then they are legally obliged to carry out CPR if his heart stops. This is something I wanted to avoid with both mum and OH.
 

Duggies-girl

Registered User
Sep 6, 2017
2,147
Hi @Bettusboo I had a DNR written up for dad by his GP. It was the hospice nurse who first mentioned it and I agreed as did dad's GP

Dad was probably 88 or 89 at the time and he had an advanced terminal cancer and was not able to have any treatment. Dad was also far too frail to withstand any resuscitation attempt anyway so it seemed to be the best decision at the time and in truth I know it was.

If it had been a couple of years earlier I would have given it more consideration although I think that I would probably have came to the same decision.

It is a hard decision to make and you don't have to make it if you feel it is not appropriate for your dad.

I know that it was the right decision for dad as CPR is brutal and rarely has a good outcome for the elderly.
 

Bettusboo

Registered User
Aug 30, 2020
18
Hi @Bettusboo I had a DNR written up for dad by his GP. It was the hospice nurse who first mentioned it and I agreed as did dad's GP

Dad was probably 88 or 89 at the time and he had an advanced terminal cancer and was not able to have any treatment. Dad was also far too frail to withstand any resuscitation attempt anyway so it seemed to be the best decision at the time and in truth I know it was.

If it had been a couple of years earlier I would have given it more consideration although I think that I would probably have came to the same decision.

It is a hard decision to make and you don't have to make it if you feel it is not appropriate for your dad.

I know that it was the right decision for dad as CPR is brutal and rarely has a good outcome for the elderly.
I would make the same decision. I just feel it would be too difficult to discuss with my father at the moment.
 

nitram

Registered User
Apr 6, 2011
21,299
North Manchester
I prefer the acronym DNAR (do not attempt resuscitation ) as there is little guarantee that it will be successful in the elderly.

It is a violent and traumatic attempt to bring back to life a person who has died, it is not withholding any treatment or medication which could prolong life. The result can be an impaired life.

Try and think what your father would prefer.
 

imthedaughter

Registered User
Apr 3, 2019
523
I also had the care home and Dr asking very early on - if you don't have LPA they are probably trying to get the answer from him ASAP in case capacity is judged to be lost. If you can help get that subject broached with him, all the better, as far as they are concerned. I don't think it means anything like end of life is near or something else, it seems to be an admin exercise.

Now, if they'd asked me in your place with my dad, I would have said DNR/DNAR immediately - as @nitram rightly points out, it's very invasive, and recovery is very hard, painful, and long, assuming it would even work. And indeed I believe that the Dad I knew would have felt this way. My best friend's dad was a successful resus when I was a teenager and he was very poorly for a long time afterwards.

However, on the day a Dr visited Dad he was having a pretty jolly day and seemed quite together, so his capacity was judged to be intact, so they posed the question to Dad and he insisted that he be resuscitated. So that is on his medical notes - ATTEMPT RESUS.

Dad often talks about his life after the care home, and in his mind he's still a young man so of course, he wouldn't agree to DNR. What will be will be I suppose.

With that said, don't feel too pressured to agree to DNR if you don't feel strongly about it -I am having to trust that when it's truly his time, Dad will go.
 

anxious annie

Registered User
Jan 2, 2019
601
It's a really tough decision and everyone has different thoughts on this. My mum's GP asked and my sister and I agreed readily to the DNAR as we had seen what our dad went through a few years previously before he died of a heart attack. As @nitram says, it is a violent and traumatic process.
 

Weasell

Registered User
Oct 21, 2019
760
I prefer the acronym DNAR (do not attempt resuscitation ) as there is little guarantee that it will be successful in the elderly.

It is a violent and traumatic attempt to bring back to life a person who has died, it is not withholding any treatment or medication which could prolong life. The result can be an impaired life.

Try and think what your father would prefer.
This is my opinion.
The most likely outcome is broken ribs.
Try and think what your father would prefer, is such a good way to look at the situation.
 

Canadian Joanne

Volunteer Moderator
Apr 8, 2005
16,764
66
Toronto, Canada
I was asked this question and based on what my mother had said when she was well, we went for a DNAR. As @nitram says, it's not about withholding treatment or medication. It is simply allowing nature to take its course.
 

Duggies-girl

Registered User
Sep 6, 2017
2,147
I would make the same decision. I just feel it would be too difficult to discuss with my father at the moment.

I agree with that and I know what my dad always said previously 'Shoot me if I ever get like that' but in the end when he was obviously in a bad way to everyone else, he thought he was fine. His GP (a lovely man) came to his house to discuss it with dad and after talking to him he decided that dad did not have the capacity to understand his position and he signed the form anyway with me on it as POA and I kept it in a safe place where everyone knew about.

To be honest a quick heart attack would have been a blessing for my dad.
 

jennifer1967

Registered User
Mar 15, 2020
1,286
Southampton
i havent been asked yet but there is that line in a mourning verse that says i would not like to bring him back to suffer again and thats where i would base the decision
 

CardiffGirlInEssex

Registered User
Oct 6, 2018
229
I was asked this last week about my Dad, who does not have dementia but is currently in hospital. I am in the fortunate position that these discussions have been had with both parents, and they in turn with their GP, so I know their instruction is DNAR and also no invasive treatments. Mum had capacity when that was done so it holds good now that her capacity is diminishing.

Important for all,p of us to think about this for ourselves and formally record our wishes, so that our partners and/or families know the answers if they have to make those kinds of decisions.
 

MarleysMum

Registered User
Sep 17, 2020
22
A few years ago when my father in law was in hospital and basically dying we were asked for our preference (we had no legal say). It was kindly explained what resuscitation would involve on an elderly person and armed with that information plus his condition we put in writing DNAR, although the hospital didn’t have to abide by that. Maybe you could express your wishes like that, whatever they may be ? My dad has Vascular dementia but is physically quite healthy yet when I had to call an ambulance when he fell last week the paramedics asked if he had a DNAR which was a bit of shock. We’ve had the coversation plus I have POA so I know his wishes (dnar). I’m no expert but in the absence of anything legal by a relative I think the hospital would just act in the best interest of the patient
 
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Wifenotcarer

Registered User
Mar 11, 2018
328
Central Scotland
I was asked to agree to a DNAR for OH (PWD) last month when he fell and was rushed to hospital with a broken hip. The surgeon who was about to operate was very kind and explained that OH was not a good candidate for a major operation, only had a 50/50 chance of surviving it. He also explained the purpose of the DNAR and what it entailed. I did a quick call to both Daughters and satisfied that they concurred I gave my consent to the DNAR. In the event he physically came through the lengthy operation perfectly, although his dementia has worsened considerably. I know it was the right thing to do but it did feel like signing his death warrant. A bit like taking your cat to be 'put down' only worse.
 

Fitzalan

Registered User
Apr 25, 2020
17
My mum, aged 94, was asked to sign a dnr form when she went for her medication review in February, so it does seem to be something some GPs are pushing for at the moment (possibly covid influenced). As the Dr explained it (though I'm not 100% sure it is the case) if there was no dnr in place, then it would be down to the attending physician to make that decision if the need arose. Mum hasn't signed it anyway - I never thought for a moment that she would. I'm sure that if she could afford to be frozen and revived when there were cures for her ailments she would have signed up years ago!