Help, hospital has decided my dad is DNR but haven't told him!

purple.sarah

This isn't a money saving question but I've found the advice on here helpful before, so here goes:

My dad is in hospital, seriously ill but stable with Emphysema and associated complications. A doctor has recently informed my mum (who is separated from my dad but still visits) that they will not move my dad to intensive care if his condition deteriorates and they will not resuscitate him if his heart or breathing stops. They have decided he is DNR but they haven't told him about it in case it upsets him!

I generally agree with the decision because he has a degenerative disease and a poor quality of life, which would be worse if they brought him back with brain damage from oxygen deprivation, which they explained is a risk with resuscitation. However I disagree with the way it was handled. I think it should have been discussed with my dad, who is conscious, coherent and capable of contributing to the discussion. My mum feels he would not want to be resuscitated.

So my questions are:

Is the hospital allowed to just declare someone DNR without even discussing it with them and present it to the family as a done deal?

Should we discuss it with my dad to see what he wants and so it won't be a shock if he finds out some other way such as seeing his medical records?

Does anyone have any experience of having this sort of discussion with a loved one? How should we handle it to cause minimum distress?

themull1

If it was me and my dad, i wouldn't tell him,but i know that both parents have told me that they dont want to be resucitated in that sort of scenario. But every family is different and it would be up to you to decide whether to tell him.

Northern_Princess

My dad was DNR and he didn't know about it. My dad had terminal cancer and a heart problem. The doctors approached us and had made the decision based on what quality of life he would have if they had resuscitated. We told them in no uncertain terms our dad was the type of person who would want to make that decision for himself. Against their advice we brought it up with dad in a round about way and he himself said if anything happened he did not want to be resuscitated. I was shocked a decision like this had been made by medical staff on a patents behalf to be honest.

I do not know the legalities of DNR and never thought to follow it up as dad died a few weeks later.

As for raising the subject with your dad we never told our dad the medical staff had made this decision. He was discussing his future treatment with us when we raised it so in the end it was his decision. If he'd said he did want to be resuscitated we would have made his wishes clear and gone to whatever level needed to comply with his wishes.

I hope your dad remains comfortable meantime.

podperson

Tbh if it was me I would want to know. I would hate the idea of people making life and death decisions about me without even bothering to inform me of it, let alone ask for my input. I appreciate that it would be much harder to tell a loved one though. You know your dad better then anyone on here is going to do - would he appreciate being informed of what was going on or would it just upset him?

margaretclare

One can only answer this kind of question from a 'what if it was me' perspective.

I would always, always, always want to know about any important and irrevocable decisions made about me/for me/on my behalf. I object most strongly - always have done - to any decisions made without my full co-operation and awareness. I also apply that to anyone near and dear to me.

An example: 4 years ago DH was seriously and life-threateningly ill in Critical Care because a 3rd replacement of the same knee had blown up an infection and he developed septicaemia. He was completely out of it and on life-support. The orthopaedic surgeon came round and opined that he might be better off without the lower part of his L leg, the infection might have come from a pre-existing and long-standing phlebitis. Discussing it with me, I said that DH should be the one to make any such major decision and if possible, wait until he came out of it and ask his opinion. I thought that neither I nor his son or daughter should make that life-changing decision on his behalf, but if it was a question of saving his life, well, of course...The surgeon thought 'as he seems to be holding his own at present we'll delay'.... In fact, DH did come out of it and opted not to have an amputation but to go for a 4th replacement of the same knee if at all feasible. He still feels grateful for me for my intervention, he has 2 legs to stand on even though they'll never be the same as they used to be.

I agree with the responses above.

milliemonster

As a nurse myself and having to deal with this kind of scenario on a frequent basis, I can tell you that unless someone is incapable of understanding the consequences or information given, there is absolutely no reason why the medical staff should not have discussed this with your father, fear of just 'upsetting' someone is a cop out to be honest with you.

Most importantly for you to understand is that escalation of treatment and resuscitation is a medical decision alone and a decision of this nature is taken if the multidisciplinary team in charge of the patient's care agree that this element of intervention is futile and not in the best interests of the patient, the discussion should be held with the patient and family members if appropriate, but only to paint the picture of the situation and inform them of the decision made, not to ask their permission if that makes sense.

If it is handled sensitively and professionally, most patients and their families understand the reasons behind the decision made, but it is important that the DNAR is reviewed on a daily basis or when/if the patient's condition improves.

At the end of the day, resuscitation is brutal, it is not like you see on holby city or casualty and is not a dignified way to die if the probability of it being successful is known to be very very poor beforehand.

I hope you can gain some clarification from the team looking after your father and push to get their cooperation in discussing this with him.

zaksmum

My dad was also DNR which we had no idea about till after he passed away and we requested his notes.

The hospital tried to say they had discussed it with us but they most certainly had not.

Dad died alone in a side ward after choking on his early morning tablets. We are haunted by the thought that staff might have witnessed this and because of the DNR, just stood by and let it happen.

marywooyeah

zaksmum wrote: »

My dad was also DNR which we had no idea about till after he passed away and we requested his notes.

The hospital tried to say they had discussed it with us but they most certainly had not.

Dad died alone in a side ward after choking on his early morning tablets. We are haunted by the thought that staff might have witnessed this and because of the DNR, just stood by and let it happen.

that's absolutely awful zaksmum I'm so sorry for you and your family xxx

floss2

I guess another thing to think about is the stress and trauma it may cause to have the subject brought up by the medical team - is your father heavily medicated or does he have difficulty talking or communicating?

j.e.j.

This is just a general question, but doesn't a patient have to give the hospital permission to discuss their health with other people/family members?

I am not of course saying they shouldn't be talking with OP's family at a time like this, but I thought medical information is confidential, even if it's family members?

So from that regard it does sound naughty that they are not discussing something like DNR with the patient himself.

FBaby

The hospital Trust, or local PCT MUST have a DNR policy. You could ask to see it and confirm they are following the policy. Most likely if you google the trust/pct, you will be able to find it.