Why we need to reexamine how doctors use Do Not Resuscitate (DNR) orders - Jayne Dowle

It is literally a matter of life and death, so why is the issue of bringing back a person’s heartbeat – or not – being so badly handled in our hospitals and across the NHS? It’s causing heartbreak, confusion and anger.

Until last week, when a hospital doctor first raised the matter of ‘DNR’ (Do Not Resuscitate), also known as DNAR (Do Not Attempt Resuscitation) and DNACR (Do Not Attempt Cardiopulmonary Resuscitation), I’d never deeply considered that in the event of a person’s heart stopping, or them stopping breathing, all medical efforts would not necessarily be made to bring them back and keep them alive.

During the Covid 19 pandemic, I’d heard rumours that ‘blanket’ DNAR orders had been put in place in care homes, meaning that if elderly and vulnerable people fell ill, cardiopulmonary resuscitation (CPR) would not be attempted.

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Several reports did indeed surface over the alleged inappropriate application of do not attempt resuscitation orders during this period.

A file photo of staff on a NHS hospital ward. PIC: Peter Byrne/PA WireA file photo of staff on a NHS hospital ward. PIC: Peter Byrne/PA Wire
A file photo of staff on a NHS hospital ward. PIC: Peter Byrne/PA Wire

The NHS’s annual Learning Disability Deaths Review for 2021 discovered DNAR orders were only followed correctly in 60 per cent of deaths in 2020 and found evidence of “learning disability” being listed as a reason for not resuscitating a patient.

Terrible though it was, I’d considered this the inevitable outcome of just one of the many questionable decisions made during this extremely difficult time for the NHS.

But then my 80-year-old mother ended up in hospital, and has now been there for three weeks. Her medical conditions are complex; she’s not keen on eating and her mobility is poor.

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There’s a possible diagnosis of a degenerative brain condition.

She still, however, has her faculties, remembering family birthdays, asking about the dog’s latest misadventures and demanding clean nightgowns.

She is still my mother, my father’s wife – of 60 years – my sister’s mother, and grandmother to four young adults. She is not a name and number on a list, to be ticked off as though she was a box of surgical gloves.

Yet that is the way she was treated, when the doctor called us in to decide on putting a DNR in place.

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A few days earlier, a different doctor – she has rarely seen the same one twice on daily rounds – had approached the matter with me.

His manner was calm, almost apologetic. I said I felt it best to discuss the situation with father and sister, read around the subject and take advice from others who had been in similar situations with their own loved ones. Then we’d be ready to talk with my mother and the hospital.

And so there we were, on a Sunday morning. Dad and I had decided we would rather not have a DNR in place; dad because obviously, he wants my mother to be here for as long as possible, and me because I have religious faith telling me life should be preserved, but no faith in the NHS to not go for the cheapest option wherever possible.

The after-effects of CPR on an elderly body are not good. This is one of the major reasons put forward in favour of having a DNR in place.

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Broken ribs, brain damage through lack of oxygen. ICU beds are expensive. Younger, fitter patients should be prioritised, the pro-argument goes. It’s a logical one.

My sister, who cared for her late elderly father and mother-in-law, could initially see the pragmatic side of DNR and spoke about the importance of “a good death”.

Our dilemma mirrored that of many other families asked to decide.

When the doctor said he wanted to speak to my mother directly and ask her to share her own wishes, I asked him to be gentle and to choose the least upsetting language possible.

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After all, this was a frail, tiny and anxious 80-year-old lady he was speaking to.

His opening gambit was, “So, if you became seriously ill and your heart stopped beating, would you want somebody jumping on your chest?”

She looked terrified and shook her head. I turned to him and pointed out that, with respect, his language was inflammatory. Then my mother shut down and refused to engage any further.

After 20 minutes of further mental ping-pong, explaining our views, taking into account my mother’s own feisty nature and legendary determination, he finally conceded that in this case, a DNR would not be signed. Mishandled, badly.

Were we right? Were we wrong? I pray that we will never need to find out. What I do know is that Do Not Resuscitate needs a serious shot in the arm.​​​​​​​

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