DNR

I really do think that GP should discuss DNR with patients before they become very ill. When they are rational and can weigh up their options and maybe discuss with their family if they wish that. It is unfair to ask when a person is feeling very ill and maybe feeling pressured to agree. The option of leaving it to family to make the decision is very unfair as some may feel guilty which ever way they decide. Best we are all asked our opinion whilst we are well to make an informed choice.

DH and I had the discussion about DNR and he was adamant that he wanted one in place. His doctor visited us at home and gently broached the subject - he was quite relieved when we told him we had already discussed it. What surprised the doctor was that the form he had only required him to sign, so asked both DH and I to sign in a space under his signature.

When is a good time to be asked this? My husband was in ICU in America and due for an operation . The nurse asked me if he was DNR and I replied yes. I knew how I’ll he was and I know what he would have wanted. To me it was simply part of looking after him

Such sad stories here. A lesson for some (but not all) staff - it's the way you bring up this subject that makes all the difference.
The staff involved in my mother's Liverpool Care Pathway were extremely kind and went to great pains to involve us at all points. Given how much pain she was in it was a blessing when she slipped away.

My Dad had a DNR in place - he was very poorly; had had Type 2 Diabetes for 20 years and then got lung cancer. but he died peacefully at home. In contrast, my poor Mum didnt and had to go through weeks of them trying to keep her alive when she was, basically, on life support, until they took her off it and she spent 2 hours struggling to breathe before she died. Unfortunately, the NHS has to save a patient if they can, no matter if only for hours. Otherwise, thanks to the pro-litigation culture that we've adopted from the USA, they can be sued. Often, it's the cruellest thing to do.

My husband's health had gradually deteriorated after a lifetime suffering from Chrone's Disease, circulation and heart problems, and a stroke.
We had watched a friend's distress, when her husband had been resuscitated and treated with antibiotics in a nursing home for 18 months, even though he was comatose for most of the time. The staff said that they had to keep him comfortable.
When DH suddenly became ill, and was taken to hospital, it was obvious that, if he recovered, his quality of life would be even worse than before. The doctor had a quiet chat with me, and asked for my opinion. I told him, though it broke my heart to do so, that he would not want to continue living in such an unhappy situation, and that we should let him go peacefully. They transferred him to a private room, and he slipped away the next morning.
Although it was a shock to finally lose him so quickly, I don't regret my decision. He was 82, and had suffered enough from operations and ill-health. I think that he was ready to go, and I hope that I will be treated in the same way, if the circumstances arrive.

Such a sensitive issue and certainly needs sensitive handling by all concerned. I think we should all think about our wishes and make them clear to all who need to know but as my 94 year old Mum said, when asked the question recently, whether she would wish to be resuscitated, 'it would depend on what the outcome would be'. She was not willing to say "yes, please DNR me under any circumstances". Some people know that is what they would want after a certain age but my Mum is not there yet! I recommend reading "In the Midst of Life - what makes a good death" by Jennifer Worth (Call the Midwife).

When my husband was dying doctor got me and my son to sign one,i knew thats what he would have wanted , we talked about many times

stella49 I don't think the expense is the only issue that the staff take into account when putting someone on life support. It can be traumatic for the family. A relative recently died after a period on life support, the decisions they had to take about dialysis and when to turn off the machines tore the family apart. But not only that when she was finally removed from the machines her face was bruised and mishapen where the mask had been. It wasn't an easy death for anyone. And the NHS staff know that it isn't.

I took my Mum to see her Parkinson's Specialist and the same thing happened! She happily countersigned the pre-signed DNR and had me put put a copy in the door of her fridge.

Our NHS must have a checklist with that DNR question on it. We need one of our newspapers to conduct an investigation starting with a Freedom of Information request.

It strikes me that some doctors need 'training' in how to be human!

My husband has had years of poor health and he has made it quite clear that he wants DNR. Death is not a surprise, something we must all face up to. Resusitation is not a walk in the park and needs careful consideration. I think the way we live is the most important part.

Precious

My mum was being treated for cancer which she had beaten 5 years before she was a wonderful and caring person but very nervous and didn't know she was terminally ill.She was woken up at 11 at night by a foreign DR who told her as you are terminally ill i need to to sign a form regarding resuscitation!She lived for 6 months and never spoke to anybody again ,she was in shock and the fact that she had been told so brutally she wouldn't live to see her previous granddaughter grow up.I took the DR to a tribunal who was totally dismissive to me stating he had no regrets about telling her this,I told him his bedside manner was appalling and hoped no-one would treat his mother this way.The way my mother died still haunts me!

lovebooks, I'm sure I speak for all of us when I wish you a successful outcome and an easy recovery. Good luck .

I am about to go into hospital for some fairly serious surgery, and I shall make sure I take a copy of my Living Will with me.

with not will

I believe that doctors these days are trained to speak very bluntly to patients.

The situation with health care is that it is extremely expensive to resuscitate - the person automatically goes to the Intensive Care unit afterwards and might be there for days or weeks, at a huge expense. Hospital staff are made acutely aware of this, and are expected to justify "why" they instigate a resuscitation , especially on older patients and those will existing conditions which are life-limiting.

It is sensible for everyone in our age group to think about this , and to make an Advanced Health Directive which clarifies all these decisions. That way you don't end up being asked about it when you are ill and vulnerable.

When my mum was in hospital we discussed DNR with her and so did the doctor. I am so pleased we did. She seemed to be recovering from her accident but developed pneumonia and died very suddenly. I asked afterwards and staff said that wihout the DNR they would have had to resuscitate her and put her on life support. She was 95 and died quickly and peacefully it was a shock for everyone but easy for her. When we asked about the DNR one of the nurses said to me that she would want that for her own mum. Mum was very happy to discuss it and wanted it. She had worked in hospitals and seen the damage that was sometimes done during resuscitation attempts.

Thank you agnurse, I sort of knew that resuscitation was not an option, and just knew that the last time he went into hospital he would not come home again. But I couldn't tell him that, as I'm not sure he knew how very ill he was. Just still feeling very sad.

That sounds sensible agnurse.

Blue

While I agree it could have been handled better, when we consider that CPR is treatment, it does not have to be offered in cases where it would likely provide no benefit.

Death is not usually a sudden event where a person keels over and that's it. In many cases, the body progressively shuts down over a period of days to weeks or longer. In those cases it would not be appropriate to provide CPR because it would be unlikely to be effective. If you didn't have an infection it wouldn't be appropriate for a provider to prescribe an antibiotic, correct?

In my area we have something called "Goals of Care". People can choose from resuscitative care, medical care (treat active medical problems and admit to hospital but no resuscitation or ICU care), or comfort care (treat symptoms only). There are further distinctions within the different levels. When a patient is in hospital, the goals of care must be discussed with them. Note that a person can also change their goals of care at any time. The sheet is kept in a "green sleeve" at the front of the chart. When the patient is discharged, the Goals of Care sheet is photocopied and the original is sent home with the patient. We tell people to keep it on their fridge. This way if they have to call EMS the crew know where to look for it and can find out their Goals of Care in a hurry if necessary.

Sorry to hear that Blue45Sapphire.
On the other hand my Dad (a doctor who'd worked in end of life care) had a definite DNR in place yet, when he arrested while in hospital, was resuscitated. He was furious and distressed. He died the next day having insisted on a glass of champagne in full knowledge that it would go straight to his lungs as he'd lost his swallow reflex. The doctors demurred but we backed him up and shared a last toast. That was the way to go - in full control.

During DH's last week in hospital his consultant told me that they me that they did not intend to resuscitate him, which basically I agreed with as I knew that his organs were failing due to the incurable cancer which had taken over his body and everything was shutting down. By that time I just wanted it to be over. He died peacefully a few days later with all of us around him, and thankfully was never in any pain.
But it would have been nice to have been asked my feelings over the DNR rather than just be told.

I think you were approached in an insensitive manner and I am glad you made a recovery.

They ask you if you wish to be resuscitated if you are having an operation but that is a different situation.