My wifes friends father is ill in hospital, not sure on entire illness but blood has cancer in it or something like that. Anyhow, wife says that the hospital have said if he has a heart attack they wont resuscitate him as he is too ill to do so??????.
That sounds strange to me i thought they have a moral/legal duty to do so?
It's a DNAR order.
They are used to prevent the kind of futile attempts at resus that would otherwise occur. It's an attempt to avoid someone putting him through an undignified and uncomfortable procedure with no benefit to him.
Ok, so its normal situation then. Just surprised by it. I mean who gets to decide when its quits and your not worth it?
*not having a pop just surprised.
The immediate family would have been consulted before the order is made
All above board and perfectly normal. I had this with both parents as they were nearing their last days. Who gets to decide? - the professionals.
We were "informed", not consulted.Mantastic - Member
The immediate family would have been consulted before the order is made
Well my wifes friend (the daughter) apparently wasn't but there is a wife so guess it was her that was consulted.
It's a tricky situation. The actual decision is a professional, medical one, taken in the best interest of the patient, and it is not something that is left up to a relative to choose, but it is done with their understanding and hopefully with their consent.
It avoids the situation of someone with a terminal illness, or in a situation where they are not expected to recover from being the subject of a futile resus procedure. Without it, the staff would be obliged to attempt to resuscitate the person, however hopeless.
Used correctly, I think they are a step towards a humane and less invasive death in hospital.
...and they do not remove the duty of anyone to do everything else for the patient, ie, its not an excuse to ignore any other needs.
MrsGrahamS has to make DNR decisions as part of her job.
They are never made lightly.
It is (yet another) aspect of being a doctor that I don't envy her for. 🙁
Interesting stuff. I have experience of this with my father.....but he actually wanted the do not resus and had filled in the relevant forms etc to make sure his wishes were carried out. He had had enough, i wasnt happy but had to respect his wishes, after all he was the one suffering.
I didn't realise though that the medical profession could also decide off their own backs. Surprising, but i guess understandable in some cases. Hard decision i wouldnt want to make.
It's meant to take the responsibility away from others, and to avoid the situation of making relatives have to choose between trying and not trying. It also avoids that 'see him off for the will' situation.
Not done lightly, reviewed every 3 days, and can be revoked at anytime by a doctor.
We use them a fair bit, but always make sure each day is taken as it comes; we do reverse or revoke them when peoples situation changes.
Used correctly, I think they are a step towards a humane and less invasive death in hospital.
Or at home, hospice, care home.
Most health care happens outside of hospitals.
I would imagine that the decision being made by a medical professional will be so that the 'right' thing is done by the patient, instead of perhaps having a person kept alive needlessly in order to satisfy the emotional demands of the relatives. The doctors are the best people to make such decisions imo.
I'd also imagine a lot more people would be kept alive needlessly if the decision were left to relatives to make. I mean, surely it would be an incredibly difficult call to make, to effectively have the final say in wether or not your loved one is kept alive or not.
Because what then of the burden of guilt on that person? 'I condemned my loved one to death'. I know I'd never ever want to be in that position.
Horrible business, but imo it's best the way it is.
We decided as a family DNR when my father was in hospital, It was explained very well to us about the out come if they did resuscitate and his chances of survival but we were given the option.
Yes docrobster, of course. My view is limited in that respect.
I do DNACPR forms about once a month. Usually after discussing with the patient, always after discussion with relatives. People need to know they are dying and understand the process.
In these days of protocols, it is the only way of stopping people like Ambulance staff or resus teams doing CPR on people about to die of cancer when the get incidentally involved. Believe me, I've seen this, and is not a good way to die, compared with peacefully holding the hand of their family. It is no accident that one of organisations leading the redesign of our local forms is SE Coast Ambulance.
Mantastic - Member
The immediate family would have been consulted before the order is madeWe were "informed", not consulted.
Yup. Same here. Bit of a shock. Was told that they would remove my old man's respiration and he would only live "for a period of time".
@ Elfin it's not about keeping people alive it's about letting them die. There is a subtle difference.
@ crikey no offence just need to emphasise death is normal and happens to us all.
The immediate family would have been consulted before the order is made
Only in the case of a living will. If the patient is deemed not having mental capacity to make the decision or has appointed a living will to make the decision. If they do then they will make it along with a consultant or 2 Drs.
One for the professionals; if a second wife approves a DNR could the adult children overrule the decision? Or would the current spouse have the final say.
(Sort of real life situation, a friend believes his father could have been saved with different treatment....)
[b]Blackhound[/b] who was the next of kin, and with whom had his dad discussed what he wanted? I suspect you'd need a lawyer...
But he needs to move on. He dosen't have to like his stepmum, but she was his dad's choice to be his next-of-kin.
I believe it is different for a Health affairs Lasting Power of Attorney - where people witnessing etc need to state if they are aware of divergent views.
Sb - don't know who next of kin would be in this situation. Father did not discuss with the adult children (would be in there 40's at the time)for sure. He won't move on I'm afraid:-(
Il take it they have put him on an Heart monitor
As has been said, it's a medical team decision. Most of the time the relatives and patient are involved in the decision too, but if CPR would be futile, often it will NOT be discussed a it can cause unnecessary stress...
I often say to my juniors that death is the one thing that happens to all of us, so why not be good at recognising it, and be comfortable in dealing with it!
I was really disappointed when a member of staff said to me "our job is to prolong life..." - I feel it's to offer quality, not quantity...
DrP
Blackhound it's not too straight forward. He'd have appointed a Living Will or Power of Attorney for the Stepmum to be involved, although this is not always the case. It could be a case of what the deceased had decided and it is extremely difficult for family members to remove.
If there is a DNR in-situ, in date and completed correctly then it should be followed. At times some relatives aren't aware and will speak in dispute of this it makes things very difficult for all, the relatives and health professionals involved.
If you're friend wants to find out more he'd need to request it through the hospitals PAL service who will help him with what to do.
Thanks Drac. Your second para is probably correct in this particular case. This was 6 or maybe 7 years ago now in a health authority that is regularly in the news for all the wrong reasons. (Police were not interested etc). I get an earful from time to time on this and a few other subjects!