DNR stands for “do not resuscitate”, which is an end of life decision, but is limited to CPR, which are chest compression and having the heart re-started. This is not the only decision that might be an end of life decision, so consideration needs to be given to some of the other possible decisions as well.
CPR is rarely offered to the very elderly and those younger people who are dying, as the outcome of this procedure is likely to be very poor. For the very frail and very elderly CPR may not work and even if it does, they are likely to be in a very very poor state of health, if they do survive the procedure, which means that they are likely to die in the next few days in any event. This can mean that the last few days of a person’s life is spent in pain with broken ribs from CPR, which is not an outcome that the person or health professionals caring for them would want. This is the reason it is often not offered.
There are lots of other decisions that involve end of life considerations that are not just DNR, although this has sometimes become a shorthand way of describing end of life decisions. Things such as receiving food and fluid will protect life or if withdrawn, will eventually end life. Antibiotics can help if someone is infected with something, but that infection might be allowed to run its course and end that person’s life, by not administering them.
Each person will have their own health issues and their own unique time when it is the right time to stop having medical interventions to keep them alive and the choice then is just to keep them comfortable.
I had a client who decided not to have a new pacemaker battery fitted, initially it would not have much impact, but eventually that decision was likely to lead to heart failure and death. But not everyone has a pacemaker and for others there might be different decisions to make that relate to end of life.
DNR in strict terms just refers to one thing, but carers and health professionals should have a much broader conversation about what the person wants at the end of their life. What their view of the balance between quantity and quality and what constitutes each of them, so that there is a personalised plan in place for when they become ill.
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