Do Not Attempt Cardiopulmonary Resucitation ( DNACPR) - Have you had these conversations?

[Raja]

My rare weekend away from work has made me think about the multiple conversations I have had over the last 10 months or so regarding DNACPR during COVID 19. I feel like COVID has really brought DNACPR decisions into the public eye maybe for the first time, at least in the UK.

Quote

CPR is undertaken in an attempt to restore spontaneous circulation and breathing in a person in cardiac and/or respiratory arrest. CPR is an invasive and traumatic medical intervention and usually includes chest compressions, attempted defibrillation, injection of drugs and ventilation of the lungs. In some cases spontaneous circulation may be restored by prompt defibrillation alone

From The Independent, under UK law, do-not-resuscitate decision is one made by clinicians and does not require consent but after a High Court case in 2014 clinicians are required to consult the patient or their families, except in limited circumstances. A decision not to resuscitate a patient must be an individual one and not a blanket approach. Not sure what the laws in other countries are regarding this.

During COVID, and even before that I suppose, there has been significant concern that doctors are putting 'blanket' DNACPR orders on groups of patients ( people with disabilities, people in care homes)  the Care Quality Commission, the organization that audits NHS providers is currently working on a report of DNACPR during the COVID pandemic.

Just some background on DNACPR survival from RESUS UK

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In hospital, the chance of surviving cardiorespiratory arrest to discharge varies considerably and depends on many factors, including comorbidities and the cause and circumstances of the arrest. In most hospitals the average survival to discharge is in the range of 15-20%

Where cardiac arrest occurs out of hospital and resuscitation is attempted, the average survival rate is lower, usually 5-10%

I know this topic might be *too* morbid for some people, and that is totally fair, but I feel like conversations like this are beneficial to have about each other, with our parents/ grandparents, it's much easier to have these conversations far in advance of someone being sick, as opposed to when they get really poorly. Have you had these conversations with your parents, grandparents or perhaps about yourself?

[kairparavel]

These are difficult conversations made more so if you don't come from a family open to vulnerable communication. It's something I very much miss about my father. In the years before his death we had a conversation about what he wanted for funeral arrangements and he spoke openly about his wishes. My sisters had similar conversations with him as well. No one expected him to die at age 57 but we were at least clear on what to do for him. We never got to the DNR conversation but I suspect we could have had it if I had asked. These conversations with my mother or sisters are a non-starter. 'Don't be so morbid!' when I tried to get similar funeral arrangements out of her. It's all written down in a will but the idea of being aware beforehand is apparently verboten. Recent health events have made it clear I need to revisit this, but over the phone is all I have and it's too easy to hang up. Maybe I'll bring it up in the next group family email with the three of them. That should go over well. 

As for myself and MC, we have discussed end of life arrangements including DNR  but not getting far because I just do not know and I'm uncomfortable with discussing my own mortality. I am my mother's daughter in that regard! 

My desire to not live an incapacitated life is trumped by my absolute terror of death, leading me down the 'some life is better than no life' path. I know that's ridiculous but until I can make peace with my non-existence I will never be able to make clear-headed decisions. 

 

[Fragile Bird]

I made my brother update everything two years ago when he had surgery for an aneurysm found behind his stomach. That was very serious surgery.  He’s a lawyer and a large part of his practice is wills and estates, so it wasn’t difficult. He also needs to update all my stuff, it’s been a decade or so since it was done.

I think many people don’t realize that resuscitation attempts made in older people (and younger ones as well) can result in broken ribs and other injuries.

[Mlle. Zabzie]

I have a living will.  My husband and my sister know what I want (and where the living will is).  I know what my parents want as well.  This is an important conversation to have.

[Mr. Chatywin et al.]

A few weeks ago, per his wishes, we had to take my father off of life support after a catastrophic TBI. It was for the best. 

[Mlle. Zabzie]

8 minutes ago, Tywin et al. said:

A few weeks ago, per his wishes, we had to take my father off of life support after a catastrophic TBI. It was for the best. 

I’m so sorry to hear that.  My condolences to your family.

[Xray the Enforcer]

2 hours ago, Tywin et al. said:

A few weeks ago, per his wishes, we had to take my father off of life support after a catastrophic TBI. It was for the best. 

I am so sorry for your loss. My condolences to you and your whole family.  

[Mr. Chatywin et al.]

3 hours ago, Mlle. Zabzie said:

I’m so sorry to hear that.  My condolences to your family.

 

55 minutes ago, Xray the Enforcer said:

I am so sorry for your loss. My condolences to you and your whole family.  

It's all good, but it serves as a reminder that it's important to sort these kind of things out well in advance. 

[DMC]

Sorry to hear that Ty.  My condolences.

[Raja]

Ah, that sucks Tywin.

4 hours ago, kairparavel said:

As for myself and MC, we have discussed end of life arrangements including DNR  but not getting far because I just do not know and I'm uncomfortable with discussing my own mortality. I am my mother's daughter in that regard!

Yeah, I totally understand this, and I also think it is a relatively complicated discussion to have. Here in the UK it is recommended that people have these conversations with their GPs.

I wonder what the laws regarding DNACPRs are like in the US/ Canada. I imagine they will differ by state. Over here, two doctors can make the decision that someone will not be for CPR, the patient and the family need to be informed but it is a medical decision. If patients/ the family disagree, a second opinion can be sought.

5 hours ago, Chataya de Fleury said:

I have a living will and healthcare POA. My son knows where it is, my doctors have a copy.

Over here we have some people with DNACPR bands so that paramedics and doctors know that someone is not for resuscitation, but that is rare to be honest. Sometimes even though decisions are made far in advance that someone does not want CPR, they end up getting it because they end up at a hospital/ place where no one knows their history or is unable to access a system where it makes it clear about their advance care decisions ( for example, if one's in a different country etc)

I wonder if a card in a wallet/ purse is the way to go so that the advance care decision is with you where-ever one goes.

[A wilding]

My grandmother (90s, ex nurse) has joked about getting "DNR" tattooed on her chest. She has made her wishes plain to the family, and I think also to her GP. She is pretty assertive about having lived long enough and not wanting to linger once things go wrong.

[DireWolfSpirit]

I am very Pro resuscitation, to the point of I refuse to be a organ donor as I do not want any conflicting decisions over if it's worthwhile to assist my coming back or just harvest me. My mind will not change on that and when I do die I will be cremated intact.

[Whitestripe]

On 3/13/2021 at 12:15 PM, Tywin et al. said:

A few weeks ago, per his wishes, we had to take my father off of life support after a catastrophic TBI. It was for the best. 

 I'm so sorry to hear of your loss.  I had to make the same decision in December. (three months ago today, in fact.)  Even though you know it's the right decision, it's still not easy. 

On 3/13/2021 at 4:35 PM, Raja said:

I wonder if a card in a wallet/ purse is the way to go so that the advance care decision is with you where-ever one goes.

Get the tattoo (kinda not even joking) or wear a bracelet if you are really serious. My father was accidentally resurrected twice recently, even though he had a DNR. Let me tell you that when you collapse on the sidewalk, EMS is not going to go through your wallet. My mother was too stunned to tell them to stop before they loaded dad into the ambulance, and she was not allowed to go with him to the ER (death in the time of COVID).  It was several hours later and he was already on life support when they finally called me and I was able to say "He has a DNR. Stop what you are doing."  

[Raja]

3 hours ago, Whitestripe said:

Get the tattoo (kinda not even joking) or wear a bracelet if you are really serious. My father was accidentally resurrected twice recently, even though he had a DNR.

At the moment I won't be opting out of it given that I'm 27 and have no medical issues and fairly fit.

I'm sorry about your father, that sounds harrowing. That's what I said up thread, you could have everything documented in all the right places and still receive resuscitation. We need to find a better way. I've seen some people with wrist bands, which I think is better but still someone has to look out for those.

There's also advance will orders that get more complicated than just CPR. Things like breathing machines ( such as CPAP, BiPAP) which have a mask fitted on you and help you breathe, as well as making decisions about not being for intensive care etc, but the latter are more medical decisions.

[Zorral]

My partner is of the breed that any life I have is better than the alternative, so I'd respect that if I had to make such a decision.

I am entirely opposite in my outlook.  Not existing doesn't bother me (other than learning the end of the story, but I feel that way about everything in past, so ....).  It's the getting to the point of non-existence via prolonged pain and suffering that does.  Hopefully Partner would respect that.

 

[HexMachina]

My great-aunty had a heart attack last week and is in a pretty bad way in hospital now. Some of these details may be inaccurate because she was explaining over the phone and she is 93 years old and doesn't always grasp things clearly, but the doctors apparently consulted with her and they discussed DNR, which my great aunty said yes to. 

This in turn led to the conversation with my nanna who said she would want that if her quality of life was going to go back to where she was in 2019. It was a hard conversation but important, I think

On 3/13/2021 at 10:20 PM, DireWolfSpirit said:

I am very Pro resuscitation, to the point of I refuse to be a organ donor as I do not want any conflicting decisions over if it's worthwhile to assist my coming back or just harvest me. My mind will not change on that and when I do die I will be cremated intact.

Hm. I just feel like you aren't going to be using your organs where you're going so why not donate them. And I don't believe that doctors or whoever are going to choose not to resuscitate you just to 'harvest' you. Its far more involved than that and involves weighing up your chances of survival against available resources and a whole load of other concerns. I'm not certain but k would be surprised if "are they an organ donor" even factors in, save maybe in exceptional circumstances.

Anyway as far as I'm concerned science or medicine can have my whole body when I'm gone, I won't be needing it and it may as well be of some use if at all possible. 

[DMC]

In terms of organ donating I've always said I'm happy to give them but I don't think anyone's gonna want them.

[HexMachina]

1 minute ago, DMC said:

In terms of organ donating I've always said I'm happy to give them but I don't think anyone's gonna want them.

Well, also this! In my quarter of a century on this earth I've not taken care of my body in the slightest.  

I meant they wont even take my blood anymore

[Mr. Chatywin et al.]

20 minutes ago, DMC said:

In terms of organ donating I've always said I'm happy to give them but I don't think anyone's gonna want them.

We can turn them into makeshift Mr. Potato Heads for the kids when supplies run low?  So yay? 

[Luzifer's right hand]

I never thought much about it but the life of one of my aunts was saved a few months ago by co-workers. They performed CPR and used an automated external defibrillator(they are pretty common around here nowadays). She had a sudden kind of cardiac arrest. She was airlifted to the hospital afterwards. She got an defi/pacemaker combo implanted a few weeks ago and is in pretty decent shape again and should have many more years ahead of her of nothing else goes wrong.