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

GlasweJen

One could always get around this by making a living will. My DNAR orders are clear and highlighted on the inside front page of all copies of my medical record, my mum and dad don't like it but it's my decision to take.

JC9297

meritaten wrote: »

That decides it for me - I think hospitals are best avoided if you are ill/not between 0months and 60/will cost more to NHS.
my own experience has put me off hospitals and reading this thread I am horrified - I thought doctors would at least attempt to save life. instead they make 'god' decisions on who lives and who they let die - or who they actually kill by witholding food and fluids (what a horrible way to die - anyone doing that to a dog or horse would be imprisoned - and we treat humans like that and call it 'medical care'?).
my family will have strict instructions that I am not to be taken to hospital under any circumstances. If I die, at least it will be naturally - not because some jumped up git has decided I am not worth the bother!

You really think that medical staff should attempt resuscitation on absolutely everyone, no matter what their condition or prognosis?


As to doctors playing 'god', isn't that what they do every day by treating people who would die otherwise?

meritaten

I think there is a difference - to put all their efforts into bringing people back to life - and then ordering no 'fluids or nutrients'. the one is natural death - the other is death by starvation. which is not a nice way to die. and to be honest the Geneva Convention forbids this for prisoners of war - so why is it acceptable in our hospitals?

floss2

meritaten wrote: »

I think there is a difference - to put all their efforts into bringing people back to life - and then ordering no 'fluids or nutrients'. the one is natural death - the other is death by starvation. which is not a nice way to die. and to be honest the Geneva Convention forbids this for prisoners of war - so why is it acceptable in our hospitals?

Because it allows a person who is only being kept alive by fluid & food to die to release them and their family from any further suffering. It is allowing a natural death to take place.

I have seen both my parents die on the Liverpool Pathway, both with DNR, and to be honest I would go along with the same decison again for myself, my husband or my 2 sons rather than sit & watch someone retain a scrap of life purely because the Drs keep them on a hydrating drip rather than allowing nature to take its effect.

pelirocco

My mother was in the end stage of dementia when she had a turn for the worse and appeared to be in a coma , she was placed in a side room and food and fluids were with held ( she hadnt wanted to eat for a few days anyway , her ability to swallow had gone ) ) . We struggled with this but i found a very good article online ( cant find it now ) that explained to hook someone up with this condition to fluids can be pretty uncomfortable for the patient , she would have had to be restrained and eventually her lungs would have filled with fluids ), you dont recover from dementia so it would have been prolonging a pretty miserable death anyway

In our experience it wasnt a horrific way to die , those last few days were the most peaceful we had seen her and she had moments of alertness we hadnt seen for a long way , and although we cant say for sure she didnt appear to be in anyway uncomfortable and she just slipped gently away . This might sound odd but those last few days seemed to be the perfect way to die , surrounded by love ones and no distress or pain

pelirocco

meritaten wrote: »

I think there is a difference - to put all their efforts into bringing people back to life - and then ordering no 'fluids or nutrients'. the one is natural death - the other is death by starvation. which is not a nice way to die. and to be honest the Geneva Convention forbids this for prisoners of war - so why is it acceptable in our hospitals?

You are wrongly making the assumption that a person in their final days needs or wants food and fluids . As you approach death your body starts shutting down and no longer requires anything.

tired_dad

The DNR debate has run for decades.

While it is entirely right and proper for a patient to decline resus, it is a different matter to insist on it.

Resus is a highly invasive treatment designed to bring back to life somebody that has more or less ceased to live. It works in very few cases. I don't think choice comes into it. You can't go into a doctors surgery and demand the wrong treatment for a disease. If you demanded surgery for your asthma rather than simple inhalers you'd be laughed at. To me resus is a similar thing. Either it is appropriate or it is not.

Advance directives are fine but there is a potential downside. If you choked on a bit of food in hospital, and the shock of it stopped you breathing, the staff would be prevented from resuscitating you and would have to leave you to die. A very basic bit of resuscitation might be all that would be needed to get the food out and get you back to normal. It is for this reason I would never have an advance directive unless suffering a terminal condition and in the final stages.

There are increasing moves to unify decisions in the community and hospital, so ambulance staff or GP's would also not attempt resus if an advanced directive were known to be in place.

clearing_out_my_pockets

purple.sarah wrote: »

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.

Just wanted to point out that it is perfectly possible to have a good quality of life following a hypoxic brain injury. My father was in hospital (with a DNR which we successfully had removed) and has subsequently read his medical records and got very distressed when he read the DNR part.

Variable

The amount of poor information in this thread is getting silly.
Some clarifications:

DNAR and "The End of Life Care Pathway" are two different things. Just because you have a DNAR set up doesnt mean you will have the End of Care Pathway applied to you.

DNAR (do not attempt resuscitation) is a decision that can be made by senior doctors that will withhold attempts to save your life if they feel it will be unsuccessful or if a very poor quality of life will not be improved. This decision is the doctors decision, although its nice to get the family involved, so they understand that the patient has entered a phase in their life where they may be so unwell its kinder to let them die than it is to flog them with medical management. Telling the patient may cause them a lot of distress, so somtimes they are not informed.

Being resuscitated is extemely unpleasent, it involves someone introducing an 8" plastic tube down your throat and compressing your ribcage rapidly, then, when its set up: passing large amounts of electricity through your heart (this hurts!) and injecting a variety of drugs into you that stimulates your heart and whatever else needs stimulating at the time.

At the top end of the "least likely to need resus" scale you have the old sedated ventilated patient who is unconcious all of the time with an illness that has no chance of getting better with no quality of life been kept alive by the breathing machines - It wouldnt be appropriate to attempt to resus.


Sometimes dying isnt the worst thing that can happen to you!

Sometimes been kept alive when you may be in pain/distress wishing to die or just unconcious with no quality of life while your family lovingly, loyally argue with the doctors to keep you alive!

Although these are extreme examples, most hospital patients have one or more "co-morbidities" (other stuff going on that complicates things: diabetes, tumours, lung problems etc) and hinders their chance of a successful recovery.

When things get really bad and patients are not responding to medication and or/deteriating the chances of surviving this hospital admission get really slim. At this point the doctors/consultants would consider withdrawing medical treatment and start using the "End of Life Care Pathway".

Sometimes people are too unwell to be saved, have too many complications to make them well again, its their time to die.
People may look at the medical treatment and say "the doctors didnt make him better, they failed" - but remember there is worst things in life than dying.

Liverpool hospitals used a very good pathway to provide care to a patient that was dying, so that their last few days would be pain free and comfortable. This pathway was adopted as the standard and all Trusts in the UK use their own variation, known nationally as "The End of Life Care Pathway"

It is NOT a way to euthanise people. it does NOT hasten someones death
Patients can be taken off the pathway at ANY time, it is reviewed as standard every 3 days to check whether its still apropriate.

Patients can eat and drink if they want to, though most normally are not in a condition to do so. They have a syringe driver usually containing diamorphine, a sedative, anti-sickness, and a drug to remove fluid from the lungs.

Diamorphine is important as it removes pain and gives a feeling of elation and eupheria.

When patients are about to die, generally their organs start shutting down. Patients go into renal failure, that is: their kidneys no longer remove fluid from the body (and put it into the bladder to be gotten rid of) and so the body places it around the body, like arms and legs in the form of Oedemas, around the lungs which makes it hard to breath, or around the heart which can make beating a lot more difficult.

So in short a Fluid drip will only be used where it will be more helpful than harmful!

TL: DR

Having the End of life pathway used is a GOOD thing. It is used when medication isnt working and the patient appears to be dying regardless - it is a way of ensuring their last days alive are pain free and comfortable.

Helpfulp website:
http /w ww. sheffield.nhs.uk/ palliativecare/resources/eolcp_hospital.pdf

Hope thats useful - I'll watch the thread a bit and answer questions.

Var

sassyblue

I'm shocked by some of the stories here. l must be terribly naive, l assumed DNRs would be discussed with the patient unless they were unconscious.

I really feel for you OP xxx