CPR on very old sick people.

When David was in hospital the last time, and it had been explained to us all that he wasn`t going to get better, the consultant said to us that he didn`t advise CPR if the occasion seemed to demand it. He said that not only do patients suffer broken ribs, they quite often suffer from brain damage as well, so we were all quite content to agree to DNR.

Some 90 year olds are more spritely and sociable than some 55 year olds. That's why age cannot determine it. The ONLY valid form is the official one. Cards, statements and tattoos are not and people with those but not the official ones will still be given CPR

I have no intention of having DNR written on me or my notes. i am leaving it to my children.
It won't ultimately be up to them. It is a medical decision to do CPR you can't demand it to be done if doctors deem it futile any more than you can demand open heart surgery if surgeons don't think its appropriate.

Having opted before the event for DNR if ill is virtually an invitation for medical staff not to bother to see if you are likely to survive any treatment.
Thats not what DNR means.
Thats something else entirely.
If you are "just" DNR you will still have every possible thing done to PREVENT your death, including complex surgery, but attempts to bring you back if you still ACTUALLY die wont be made.

DNR statements are a good idea - but when is the right time? Could we change our minds at that crucial point

Only the official forms are valid.
Yes they can be "un-done"
But you can't demand to definitely BE resuscitated it is a medical intervention.
Consent doesn't work that way. You can refuse to have something done but you can't demand to have something done if its not medically appropriate.
Doctors can make a best interest decision to not do CPR on someone who was for CPR and didn't have a DNR (by signing a DNR. Relatives don't have to sign it but its good practice to involve and inform them)

Message withdrawn at poster's request.

chocolatepudding that is not usual.

When a DNAR form is signed it is also noted on the 999 system (or should be).

So ambulance crew do not need to wait to see a physical form to stop/not start CPR if the person is IDed because it shows electronically on their system.

Something perhaps went wrong in the system in your example, but it is not how things usually work.

I have no intention of having DNR written on me or my notes. i am leaving it to my children.
Having opted before the event for DNR if ill is virtually an invitation for medical staff not to bother to see if you are likely to survive any treatment

M0nica I find it hard to believe that an intelligent woman, which you are, could labour under such a misconception.
It is absolutely not the case and it is a bit like people who won’t carry a donor card because they think the hospital would rather harvest their organs than save them.
It is not true.
I saw it in action with DH where every effort was made to save him after a massive oesophageal haemorrhage and even when he was in a medically induced coma after multiple organ failure the ICU doctors and liver and kidney consultants would have given him another 24 hours to see if there was any hope of his organs recovering and bringing him back if I had insisted, but we all knew he was at the end of the road. However, there was no pressure to proceed. Hard to describe but incredibly professional and caring at the same time.

.

I have friends and family who live in and around Portsmouth, and one of my uncles was in and out of hospital before his death, thankfully not Gosport, so what happened there, feels very close.

Whatever the rules on DNR, there is the danger, as previously with the Liverpool Pathway, that what starts as a sensible gently and caring way of dealing with the last day or so of someone's life becomes a routine way of dealing with seriously ill elderly people without consideration about whether they could and would want to survive.

Of course in crisis doctors make the decision and obviously, or at least I thought it was obvious, I wasn't expecting anyone to consult with my children at that stage of the procedure. I would have assumed that if I was in hospital seriously ill and non-compus then those discussions would already have taken place.

I have twice been consulted and discussed with doctors the progress and treatment plan for elderly people rapidly approaching their death and unable to make decisions for themselves and have agreed with them when it was suggested that DNR was put on their notes. That is what I have in mind for myself.

What I am not prepared to do is make an advance directive over DNR at a time when I have absolutely no idea of when in the future the notice might be written on my notes, nor the circumstances at the time.

I had to sign for both my parents deaths Dad was in his last week having a terrible time and I was asked (in no way persuaded) I was left on my own to sign the paperwork It felt awful but I did not want my Dads suffering any more knowing he was in his last few days anyway he was then put on a morphin shunt and died within two days
My mum was taken to A and E after a massive heart attack the duty doctor was kindness itself and explained they could resuscitate but it would cause her great pain and distress she had advanced Alzheimer’s and no quality of life couldn’t hear, see, walk, and was doubly incontinent again I signed the paperwork 6 months after my Dads death she died within 24 hours
I hope to goodness when my time comes it isn’t left to my children to feel the double edged feelings of guilt, relief, and sorrow of deciding my death if I make my own decision that will be one thing taken from their shoulders

This is a huge area of ethics and ethical questioning which we can't answer here. In my 30 years of nursing I feel that it was the very uniqueness of each patient that had to govern the management of care. I have seen many patients who were thought to be dying rally and go on to the amazement of us all.

BlueBelle, thanks for your post, your experience is so like mine and I'm sure, many others here. I agree with your desire to avoid, if possible, leaving our children with the double edged feelings of responsibility, guilt, relief and grief when they're left making the final loving decision they can for their parent. My family made the decision but 9 years on, I still reflect on the complexity.
MawBroon - your experiences with Paw continue to be both moving and informative x

I have been involved in DNR decisions for three very sick relatives. Only one of these was elderly. If someone has already been diagnosed as terminally ill, it would be unkind and undignified to resuscitate.

When we were doing the power of attorney for my mother I asked my niece (a medic) if it was really essential to do the health one as well. We are quite a close family and agree on most things.
Her reply was that, unless we had one, the medical staff would listen, with compassion, to our views on the care of our mother and the wishes she had expressed to us and then decide for themselves what to do. They can’t afford to be sued.

agnurse You say that blanket DNR orders are not recommended anymore but when my 93 year old mother was in hospital recently they apparently asked her if she wanted resuscitation and she said she didn't. She is starting with dementia so the circumstances are a bit unclear. She was ill but not dying at that time so none of our family explored this. Subsequently she was admitted with a life threatening infection and was treated with IV antibiotics without question or discussion. No one has mentioned "Goals of Care" and I wasn't aware it even existed. She has nothing in writing.

Lazigirl Goals of Care isn't available in Britain. It's an end of life/palliative scheme that's available in Canada, which is where agnurse is from.

All individual cases are different so a scheme whereby a person can signal their own preferences would be best. If I were in a state of permanent unconsciousness such as that bestowed by advanced dementia I would definitely not want my life artificially (and violently) prolongued but, of course, I cannot speak for others.

DNR is wanted by the individual must be completed otherwise there is a duty of care to respond with CPR by the health professionals.

We should all have powers of attorney for health and welfare to make our wishes quite clear on this sort of thing. Mine is crystal clear about what I do/don't want in the event of (God forbid) dementia or any other condition where I can no longer care/speak (with full mental capacity) for myself.

A neighbour in mid 80s who'd already had at least one heart attack was given CPR after a further one. He told me afterwards that the after effects were so painful, he wished they'd just let him die. He did in fact die not many months later.

After hearing that I had absolutely no,problem with saying a very firm no to any such thing for my mother with dementia. Though thankfully the situation never arose.

I do however think it's sometimes very difficult for medics, since some relatives do want absolutely everything possible done to keep someone going, no matter what state they're in. I've heard of cases where relatives became very indignant or even furious if it was suggested that it would be kinder just to let someone go.

My husband was ill in hospital and needed to have an operation and I was told that as he was 59 if he died he died because at that age he wasn’t viable,I was fuming. Fortunately he did get through it and I had him another 10 years

Having been consulted and having made decisions on how both my father and my uncle should be treated in the last days/weeks of their lives.

I hope to goodness when my time comes it isn’t left to my children to feel the double edged feelings of guilt, relief, and sorrow of deciding my death.
but I did not feel that. I felt a quiet release and thankfulness that, separately, two people who were very dear to me and whose death's were imminent (no matter what I did), would die in as peaceful and controlled way as was possible - and this is indeed what happened.

If someones of sound mind and THEY WISH DNR THEMSELES THEN THEY SHOULD LET EVERYONE KNOW AND ACT ACCORDINGLY- IF NOT THEN WE SHOULD ALL HAVE A CHANCE FOR AS LONG AS WE CAN!!!im glad im not in your care jessM ,medically or otherwise,im not old,(55)but i have a few medical conditions,which i soldier along with day to day,but id hate to think if anything happened that someone who thinks like you could just make that descision for me just cause im not 100% fit! i bet your older relatives are all panicking a bit.

O.M.G.madmum38,you poor things- thats such a young(ish) age really,these days.Now even IM panicking.!

My mother, when dying of heart failure aged 61, suffered a severe heart attack in hospital. She was given CPR and spent her "last" 2 days unconscious & wired up to all sorts of machines and intubated. My father was so very distressed to see her like that and it prevented my DDs from visiting her as they were young and it would have been too scary.
She, & we, would have preferred her to be allowed to die when she had the heart attack rather than being made to breathe for a further 2 days.

Five years later my dad (67) was in hospital and suffered a heart attack. He was allowed to die. It was as he would have wanted.

Doctors believed both had contracted a virus in their late 30s when living in E Africa that had damaged their hearts.

It wasn't a case of CPR, but it was down to me to decide whether an aunt in her 80s, with quite advanced dementia, a very poor quality of life and the umpteenth UTI, who was refusing food and drink, should go to hospital for drips etc., or stay at her care home with palliative care - in other words, to die.

It was a horrible decision to have to make - I could only ask the lovely GP what he'd do if it were his much loved aunt. He said he'd leave her where she was, in familiar surroundings, where they'd keep her comfortable - especially since hospital is a terrible and confusing place for anyone with dementia, and given her history it was only going to happen again quite soon.

So she stayed, continued to refuse all food and drink - I sat with her as much as I could - and drifted away quite peacefully after about a week.
Although it was a horrible decision at the time, I felt no guilt afterwards, since I'm quite sure it's what she'd have wanted, if she'd been able to speak for herself.

The medics don't always get it right. A friend's mum had a hernia which needed an operation, she was being very sick. The aneasthetist said she was too ill for the op and that she only had days to live. She was moved to our little community hospital and a week later was sitting up in bed, eating well and enjoying all the attention. She went home and carers were sent in but they gave up after she made them scones. She lived a few more years, well into her 90s.