DNR - any experiences?

talesin

After reading another thread, I got thinking. There is something I would like to talk to a lawyer about, but for now, I am interested to know if anyone has any personal / work-related experiences with Do Not Resuscitate Orders (DNRs)?

If you work in a hospital, how effective is one? Is it a notarized document? That's what I assume, but are they really enforced when push comes to shove?

It's something I've been asked speak up about in case of emergency, but I think the person should have their lawyer draw something up. Any experiences welcome, I'd like to understand it from people's points of view before I seek some legal advice. (Laws probably differ between Canada and other countries, so Cdn input would be most appreciated, as well as all others.

Thanks.

stillajwexelder

Yes - family member 86 and not well - the spouse of said family member was asked "Do you want us to resuscite " and the answer was no - no point just to let live another few months

Now if it was a much younger person I am sure it would be different

Frannie Banannie

My MS patient, Kristi, had DNR orders. She was only 37, but obviously terminal. These papers were provided by the nursing agency that helped us care for her and signed and witnessed by family members. She died quietly at home with her family around her.

DNR holds up. You just hafta have the papers signed, witnessed and handy.

Frannie

horrible life

DNR also means no WATER. No hydration at all. My sisters grandmother-in-law was in the hospital. Had DNR. Nobody would give her water, she begged for it. My sister and her husband would sneak in at night with the hospice nurse and all would give her ice chips. She got better and went home for 3 months.

She remembered everything that went on. I at least want to be hydrated. What a horrible way to go.

Sad emo

In the UK you have the request put into your medical notes. But here DNR only applies when a patient has arrested.

HL, that incident is terrible, I'm glad your sister and hubby helped her and she became well enough to go home. You'd think the staff would have allowed her some dignity. What they did was torture her.

As far as I'm aware, it's still illegal to withold (?sp) fluids/food/medication here too. To do so, the doctors have to go through the courts but its only usually done in 'extreme' cases such as PVS where it is considered that the patient will have little awareness of what's happening. (Personally, I'd question this) and there's 'little chance of recovery'.

Forscher

Wow, Horrible Life, that's the first time I've ever heard of a DNR being used to deny hydration to a CONSCIOUS, COMPETENT patient!

I used to work as a nurse. In my experience, a DNR, or no code, only applied to an unconscious patient who could not make a decision for themself at the time. Generally, a DNR order was ordered by a doctor, either with the permission of the family, power of attorney, living will, or by previous permission from the patient. A DNR only applies to extraordinary means of life saving in a critical situation. By extraordinary means of life saving, I mean measures such as, cardiac resussitation, pulmonary ventilation, and similar measures. I've NEVER seen it used to deny food and/or water to patient. The sort of thing that we all saw happen with Terri Schiavo generally requires a court order (as happened with her), and I've never even seen that done where I live to a person in a persistive vegetative state like happened to her.

Usually, such orders were given in cases where a person had multiple organ failure which required them to be on respirators and the family wanted to do a little CYA. Even then, they had to be brain-dead. That was why I, for one, found the whole Schiavo thing shocking.

I've been out of the nursing field for a little while, so i can't speak for what the current practice (last ten years or so) is. But I hope that helps you some.

Forscher

Forscher

My baby brother, who is a currently practicing nurse, just came over for a visit. I asked him about the current practices involving DNR's and boy did I get an earful! He informed me that DNR's are nothing like they used to be. It seems that they are being used in a way to bring in euthanasia through the back door. He told me that he was not surprised to hear the experience of HL, although he'd not seen it carried to quite the extreme that HL reported.

My brother told me that when a DNR is ordered, it pretty much means that staff will cease taking care of the patient. They will not give pain medicine. They will not give food through nasal tubes etc... The reasoning is that they or their family don't want them to live, so why bother? Of course, if the person ever becomes lucid they can rescind the order. That is, if anybody bothers to notice that are they awake. I was thoroughly disgusted!

He told me that he is going to execute a living will specifying in detail how he wants to be cared for in the event that he cannot do so for himself. He also advised me to do so for myself.

Word to the wise1

Forscher

zulukai

I'm a nurse in British Columbia, Canada. In all my years of work in different hospitals I have dealt with the DNR issue many times. I have never cared for a comatose patient who was denied patient care. By this I mean that the dying DNR patient was always washed, turned and diapered. We changed their linen, gowns and gave them mouth care. All that was withheld was resusitation as per signed agreement in accord with the patient's wishes.
In a few shocking cases I have seen a long lost relative come barging into a patient's room and start threatening law suits and other unpleasant consequences if resusitation is denied even if the patient had made their DNR wishes known in writing well beforehand. I've seen a couple of people denied the dignity of a peaceful death by a relative they hadn't seen for decades..a sister, brother or even an adult child who didn't bother to keep in touch until the end was imminent. And their guilt was usually the driving force behind their demands.
I hope the "living will" option has made scenes like this a thing of the past. I now work in Pediatrics and the DNR orders are reserved for only the severest of medical conditions where there's an underlying genetic anomaly ultimately incompatible with life ie: being born without brain tissue (anacephalic) etc. Or inoperable cancer etc.
When my mother was dying we couldn't bear the thought of depriving her of fluids and kept an IV running at 50cc's an hour until she passed away.This was considered more of a "comfort measure". But when you talk of keeping feeding tubes and IV's running at sustinence levels you are also talking about prolonging the dying process for weeks or months and as a nurse I can tell you that this has ti be one of the most excrutiating ways to die...by degrees.
To suffer like this then to be pounded and shocked during well meant efforts to keep one going, well it's barbaric to say the least.

talesin

Thanks for your input, peeps.

My mom has asked me to take care of this for her. The problem is that my brother feels that all measures should be taken till the last option is exhausted. She has been sick for a long time, and when her 'time' comes, does not want extraordinary measures taken if she either arrests, or is terminal.

Stilla, I agree. Though I will say that my NOK and I am his, who is only 31, also wants DNR on his file, in case he is helpless and in some kind of agony or terminal condition. His family most certainly would want him kept alive, but he does not want that.

Frannie, I'm hoping that if it is my time, that's the way it will be. It's so important to have your wishes know, neh?

HL, that is inconceivable and I think, torture! Dying with dignity is one thing, reviving someone and keeping them alive with a tube stuck down their throat is quite another. Your sister and her husband absolutely did the right thing.

Sad Emo, yes, I am thinking of DNR as just that "do not rescusitate", it's only in the case of arrest or where systems are failing and it's 'time to go'.

Forscher, thanks. I am thinking you are right, and we need to draw up a 'living will'. I have talked to my mom about a living will. Her fear is that they will put tubes in her, and keep her going when she would rather just go to sleep and have it over with instead of suffering even more. She will be conscious but unable to tell them "LET ME GO!". That is what happened to my aunt, and she suffered an additional several days with the breathing tubes down her throat, with her eyes pleading with us to take them out. It was her wish to be DNR, but we had nothing in writing ....

zulukai,,, this is what I know I may have to deal with. My bro barging in and insisting that she be kept alive by any measure, when I know she wants otherwise.

Thanks, all, for your input. It's time to talk about a Living Will, and well, that's what we're gonna have to do, I guess. It's great to be able to come here and have the value of your experiences. I appreciate your feedback so much.

xo

tal

cruzanheart

My mom had a DNR order and when she went on hospice last year, the nursing home staff went over everything to expect and asked again if we wanted that, just to be sure. No pressure, just a kind question. When Mom died, they kept her comfortable during her last hours and gave her morphine to help ease her passing. It was as easy as it could have been and I am most grateful to the hospice staff and the nursing home for letting her die with dignity.

It helped that I had read "Crossing the Creek" -- a truly inspirational insight into the mechanics of death written by a hospice nurse -- because I knew what to expect at the end and what would help and what wouldn't.

Definitely have the paperwork in order BEFORE the situation becomes too emotional for anyone to think straight.

Hugs,

Nina

DNR - any experiences?

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