DNR

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anniet
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Message 1782222 - Posted: 25 Apr 2016, 2:42:11 UTC

I hope no one minds me popping this here?

I'm expecting a short-lived thread really, as there's probably only so much that can be said about getting one of these slapped on your medical file, or indeed fighting to keep one off.

I did consider posting it in the cafe. Yes, people... I did! :) But after a think through I decided here might be better suited to the free expression of potentially contentious views.

What we do not want, in case it spreads to other threads like blight... is absolute agreement... :)

Some UK reference points (apologies if these have been discussed elsewhere):

Nearly seven in 10 people die in hospital and 80% of those die with so-called DNR or DNAR notices in place.

Which means, according to my rough estimate and based on 2013 population figures (for us lot living on our little island) 35 million of us can expect to go out feet first with one of these to our names. And in 2014, over 280,000 of us did. How many knew they were going to, I don't know and probably never will. How many had no one to speak up for them after they did, I don't know either.

Two pertinent courtcases where someone did, are:

Downs syndrome, PEG fed, bed bound and learning difficulties were why he got his... twice

She got hers removed - but three days later the hospital reinstated the order without telling her or her family

In both cases, judgement went against the hospitals and we apparently went from this position:

although the law makes clear the final word on such issues lies with medical staff, there has been an apparent lack of clarity over just how far they have to go in consulting a patient with mental capacity or their families about their wishes.

To this:

"The judgment sends a clear message to all NHS trusts, regulatory bodies and healthcare professionals that patients have a legal right to be informed and consulted in relation to decisions to withhold resuscitation."

That's good news isn't it, people :) And you will be pleased to hear that I can definitely attest that one hospital in London started doing exactly that just before the end of last year. Yes :) or rather... they did (and still are) but with a most interesting twist... to make legitimate what the ruling had illegitimised a few days earlier, and by whatever means necessary.

Paranoia on my part? Oh yes, most definitely probably - but when admin staff can walk into an operating theatre (as a patient is about to be put under) and for the second time, stop an urgent procedure without any explanation other than "missing paperwork" and you've just rejected (after much soul searching on the patient's behalf and not a small helping of hope and a lot of selfish I'm not ready to say goodbye to you yet stuff going on in your head) a DNR decision on their file (and have good reason to suspect it had been there for some considerable time before you were asked to "put it there") you might be too.

As a result, I've kind of lost my objectivity over the whole issue and need some help finding it again, before I move too far from being a non-litigating type to a kind of unstable radical wearing a sandwich board... Which is why I'm here :)

So people... DNR - who should decide? Under what circumstances might you trust someone else to make the decision for you? How comfortable would you be making the decision for someone else if they deferred their decision to you, or if a doctor did? Or anything else loosely along those lines.

How things are done elsewhere would also make for very interesting reading. We could even stray into other areas vaguely associated with the topic, as conversations often do :)

Are there "categories" or "conditions" that if you suffered from, would lead you to request a DNR for yourself, or someone else? Are there any that you think could/should be enforced on others?

All views are very welcome, and will be gratefully received.

Thank you :)

Oh, and hello everyone :) Probably should have said that up there really, but never mind. It's nice to be back :)
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Message 1782225 - Posted: 25 Apr 2016, 2:54:15 UTC

Hi Annette long time no see and all of that....
I believe in living wills. I also believe that
all such notations should be at the behest of
the patient's family, if there is no living will.
Citizens should make themselves familiar with
the current laws about this in the areas where
they live. People should also talk to their loved
ones before terrible things may happen.



edit:
I hope this is helpful to you...

re-edit:
You are looking good ...
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Darth Beaver Crowdfunding Project Donor*Special Project $75 donorSpecial Project $250 donor
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Message 1782230 - Posted: 25 Apr 2016, 3:14:05 UTC

DNR in the cases you show are medical malpractice at the least .

However you should talk to your family about not being resuscitated . All depends if you know your going to die or it's sudden weather your married or not .Nobody says anything because nobody knows if people don't make there wishes known so who's to say who ask not to and who has ask too be keeped alive from a toe tag

That hospital needs the management sacked and maybe a investigation into the NHS if you have Electronic Medical records like liked up across the whole country.

If they are could be why when it was removed it popped back up 3 days later one hospital removes it but the data centre says nope wrong data and changed it back
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Profile Gary Charpentier Crowdfunding Project Donor*Special Project $75 donorSpecial Project $250 donor
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Message 1782244 - Posted: 25 Apr 2016, 3:59:49 UTC - in response to Message 1782222.  

Apparently that (hospitals putting a DNR on the chart) is a UK thing. In the USA only the patient or a court order can put a DNR on the chart. It is why medical costs in the USA have exploded. And why there was all that talk about death panels when Obamacare was being passed.

Good to know not to go to a hospital in the UK.
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Message 1782321 - Posted: 25 Apr 2016, 10:00:14 UTC

anniet all cases are different and you cant base your argument on two cases easy as that
Life is what you make of it :-)

When i'm good i'm very good , but when i'm bad i'm shi#eloads better ;-) In't I " buttercups " p.m.s.l at authoritie !!;-)
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Message 1782335 - Posted: 25 Apr 2016, 11:33:57 UTC

"Hot" topic. I'll probably get my ass chewed out for this but IMV only. It's down to 2 things, either knowledge of the situation or info provided if none known.

A DNR was not placed on my father but we were asked. Nov 2005 received a phone call saying he had an accident & rushed to hospital. An hour after I arrived, he passed away.

Between the time of the accident & the ambulance arriving, he was without oxygen for close to 30 minutes. at 19:00 doctors told us that he had gone several times already. The family just stood there like zombies, not a word said.

Being aware of what lack of oxygen does I asked for confirmation from the doctor who said I had it correct. Told the doctor to let him go should it happen again. He passed away on the move from A&E to a ward.

To have a DNR placed with no knowledge should be a criminal offence.
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Profile Gordon Lowe
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Message 1782367 - Posted: 25 Apr 2016, 13:58:26 UTC - in response to Message 1782222.  

Just last week, I updated my Will and Estate plan. This is my Living Will:



LIVING WILL DECLARATION

This LIVING WILL DECLARATION is made by GORDON M. LOWE on this ______ day of April, 2016.
WHEREAS, for purposes of this Declaration, the phrase “terminal condition” means a condition caused by injury, disease, or illness which, to a reasonable degree of medical probability, as determined solely by the patient’s attending physician and one (1) other physician, is incurable and irreversible and will result in death within a relatively short time, and where the application of life-prolonging treatment would serve only to artificially prolong the dying process. KRS 311.621 (16).
WHEREAS, for purposes of this Declaration, the phrase “permanently unconscious” means a condition which, to a reasonable degree of medical probability, as determined solely by the patient’s attending physician and one (1) other physician on clinical examination, is characterized by an absence of cerebral cortical functions indicative of consciousness or behavioral interaction with the environment. KRS 311.621 (12).
WHEREAS, for purposes of this Declaration, the phrase “life-prolonging treatment” means any medical procedure, treatment, or intervention which utilizes mechanical or other artificial means to sustain, prolong, restore, or supplant a spontaneous vital function; and when administered to a patient would serve only to prolong the dying process. “Life-prolonging treatment” shall not include the administration of medication or the performance of any medical procedure deemed necessary to alleviate pain. KRS 311.621 (11).
NOW THEREFORE, I willfully and voluntarily declare:
If I no longer have decisional capacity, my wishes regarding life-prolonging treatment and the administration or provision of artificially provided food are as follows:
If at any time I have a terminal condition and my attending and one (1) other physician, in their discretion, have determined such condition is incurable and irreversible and will result in death within a relatively short time, and where the application of life-prolonging treatment or the administration of nutrition would serve only to artificially prolong the dying process, I direct that such life-prolonging treatment or the administration of nutrition be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain.
If at any time I am permanently unconscious and am diagnosed by my attending and one (1) other physician, in their discretion, as having a condition that is incurable and irreversible, then I direct the removal of medical treatment and equipment which sustains life, including the removal of nutrition if allowed by law; the requirement of a “no-code” or “do not resuscitate” order by any attending physician; and an order that medication for pain be administered. I authorize the termination of life support system or systems and the non-administration or termination of medicines and drugs, even if any such action shall hasten the moment of my death.
On the ______ day of April, 2016, I executed a Designation of Healthcare Surrogate, a copy of which is attached hereto and incorporated herein by reference, wherein I name my Healthcare Agent who is to make healthcare decisions for me in the event that I have been determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging treatment. In the absence of my ability to give directions regarding the use of such life-prolonging treatment, it is my intention that my Healthcare Agent shall act for me in providing consent regarding the withholding, withdrawal, or continuation of life-prolonging treatment.
In the absence of my ability to give directions regarding the use of life-prolonging treatment and/or the administration or provision of artificially provided food, it is my intention that this declaration shall be honored by my attending physician and my family as the final expression of my legal right to refuse medical or surgical treatment, and I accept the consequences of such refusal. It is my desire that my dying shall not be artificially prolonged.
I understand the severity and finality of my actions, but if I were able to participate in that decision I would do exactly what is set out above. I wish to live and enjoy life as long as possible. However, I do not wish to receive medical treatment that will only postpone the moment of my death from a terminal condition or a permanently unconscious state.
[In addition, I [authorize the giving of all or any part of my body upon death for any purpose specified in KRS 311.1929 (including research and education).][authorize the giving of all or any part of my body upon death but only for the purpose specified in KRS 311.1929(5); provided, however, it is my desire that any organs deemed fit for transplantation should be harvested for distribution through the appropriate means, but ONLY if such a feat can be accomplished without cost to my family or estate and providing it can be accomplished without undue delay.][DO NOT authorize the giving of all or any part of my body upon death.]]
[In addition, by initialing the appropriate line below, upon my death I specifically:
[______
initials]
Authorize the giving of all or any part of my body upon death for any purpose specified in KRS 311.1929 (including research and education).
[______
initials]
Authorize the giving of all or any part of my body upon death but only for the purpose specified in KRS 311.1929(5); provided, however, it is my desire that any organs deemed fit for transplantation should be harvested for distribution through the appropriate means, but ONLY if such a feat can be accomplished without cost to my family or estate and providing it can be accomplished without undue delay.
[______
initials]
DO NOT authorize the giving of all or any part of my body upon death.]
Copies or facsimiles of this Living Will Declaration shall be as valid as the original Living Will Declaration, if otherwise permissible by law.
[Signature Page Follows]

IN WITNESS WHEREOF, I, GORDON M. LOWE, sign this Living Will Declaration on this the ______ day of April, 2016.



GORDON M. LOWE
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anniet
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Message 1782829 - Posted: 27 Apr 2016, 5:06:16 UTC
Last modified: 27 Apr 2016, 5:11:52 UTC

@celttooth
What he said, people. Do it. Especially...

People should also talk to their loved
ones before terrible things may happen.

...because trying to second guess what you think the other person wants to hear you say after things have gone pear-shaped, is no way to reach a decision :/

@Darth
The problem with this hospital is that it was rebuilt under a PFI (private finance initiative) scheme which went way over budget, so that when it opened it's swanky doors and miles of empty corridors (wider than many London streets) it couldn't really afford to have any patients, but did. It is only a matter of time before a default hands ownership directly to the investing bank. It's how to privatise the NHS without the electorate knowing or realising it until it's too late. It's very very clever. It gets even more cynical than being able to point a finger of blame at the offending hospital but I'll save that for a different post.

Whilst the number of staff to patients falls, the number of management positions to "oversee the budget" rises. From what little I've managed to stumble across, I can't be sure whether we're dealing with people: deliberately hired for their incompetence, or; strategically hired for their ability to look incompetent whilst delivering on deals made much higher up.

The medical staff on the other hand are brilliant.

The wonderful nurse who performed CPR on my other half the last time his heart stopped during dialysis has now returned to her home country, because her every instinct as a dialysis nurse was being undermined by finding DNRs on patient's files and not knowing why they were there. The machines are expressly designed to extend life. They are also brutal on the heart. A dialysis patient goes into cardiac arrest every day on my other half's ward. Four nurses used to supervise 30 patients at a time on the machines and in those days, an arrest might happen once or twice a year. Four nurses now supervise 100 patients at a time. Every time they save one with CPR, they mess up the budget. That is used as leverage by management on the doctors. And that is how it works. And if a court case or malpractice suit is the result, it just pushes the hospital closer to the brink of corporate ownership.

@just messing with ya
Thank you for fixing the link :)
In the UK it appears to be the doctor who are in charge of what treatment, if any, is appropriate.

It used to be, or that's how I thought it was, but now I'm not so sure.

@Gary
Good to know not to go to a hospital in the UK.

:))) You'll be fiiiiiiiiiiiiiiine :) Just choose which hospital you get knocked down in front of carefully, and don't hang around long enough for the management to notice you're there. I'd recommend St Thomas's. It's where our members of parliament go when they fall over in the commons bar.

@Mark Stevenson
anniet all cases are different and you cant base your argument on two cases easy as that

It is and they are and you're right but that's what makes it really complicated. Throw in data protection and a 53 year old patient with all his mental faculties intact who tells you to decide on whether a DNR should or should not be put on his file (before the hospital will perform a procedure that resulted in the death of 3 out of the last 4 patients who'd had the same procedure done - and with no one able to tell you anything about those cases) and see how sane you stay :)

I'm not even sure it would be legal, and nor am I allowed to see his medical file.

@Sirius
And that's the kind of scenario I've been mentally preparing myself for, for years. It couldn't have been easy for you, I know, but a reference point you can inderstand and that can be justified, is like finding a roadsign in a fog. All I can find is fog.

@Gordon.
Thank you. :)

And to everyone else too.

oh...and did we say we like humans too? Well we do :)
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Sirius B Project Donor
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Message 1784205 - Posted: 2 May 2016, 12:56:55 UTC

Nice to see a professional agree with me...

Unforgivable faillings in DNR

..."“By ignoring people we actually give an indication that we don’t care, that we are not bothered – that is in my personal opinion a criminal offence,” she said."
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Message 1784324 - Posted: 2 May 2016, 21:15:28 UTC - in response to Message 1784318.  

Thanks Gordan for providing a template.


It's the Kentucky language, but gets the point across. My main quandary was whether to have both nutrition and hydration withheld. I decided to go with just nutrition.

Note: All in my family have one. Both my mother and father had one. The Hospital needed to see the DNR for my Mother, who was not conscious, but apparently in pain.

VERY IMPORTANT: Where is your Living Will?

In my mother's case. Before the Hospital could 'unplug' her. They had to see her DNR. It was a Sunday, and was in her Unavailable Safe Deposit Box.

I, thankfully, had a copy at my home. Retrieved it. Gave it to the Hospital. And my 91 year old mother 'passed away' that day.



Very good point about keeping important documents like this readily available. I have that sort of stuff in a safety deposit box at the bank, but everything is also filed with my attorney, and in a safe place at home, and with a close friend.
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