How do you reinstate a DNR?

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After my mom's stroke last year, she said she did not want a DNR. I am her proxy and I haven't asked her about it lately, but I see that she's starting to decline and I really want the DNR. How do I make this happen?

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Those are really tough decisions to have on your shoulders. I know. I was MPOA for my late mother and I have no medical training! Check with the Hospitalist.
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You have the Doctor sign a new form. It may not be a D.N.R. any longer most are using a P.O.L.S.T. that stands for Physicians Order for Life Sustaining Treatment. It is much more detailed than a D.N.R. you can select the type and aggressiveness of care you wish.
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My husband and I many years ago had DNR's on our Health Directives. He had heart problems and slight dementia and finally one year ago he had to be put in the hospital at age 91 and after a week had to go to a nursing home. He had difficulty in eating and the nurses suggested he have a feeding tube put in. My daughter looked up the consequences of that and wondered if he would survive the surgery to do that. In our hearts we really didn't want that, but because there was some pressure about it we were considering having it done. On a Saturday when the doctor wasn't readily available, I went home so I could try to contact her and discuss the matter. Before I even got in the door my phone rang. It was the NH calling to tell me his heart had stopped and they had tried to revive him and he didn't make it. I was told that because I was considering the feeding tube they had ignored the DNR. If I had still been there I wouldn't have allowed it. I don't know how you get the DNR reinstated, but I think you should do anything and everything to get it reinstated. I don't think my husband at that point would have been able to make a decision regarding a feeding tube or resuscitation and that the nurses should not have gone against the DNA order even though I was looking into artificial feeding. Looking back I just wish I hadn't even considered the possibility and knowing how near death he already was we did feel sure he wouldn't have survived the surgery.
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This is the second part of my post on DNR. In Alberta, any patient can have what is knows as a “Green Sleeve”. It is a plastic pocket that contains documents and that patients take with them to every medical visit. At home, it is kept on or near the fridge which is where health responders are trained to look in an emergency. Unless they see a written, signed DNR order, they are legally obliged to start CPR until the patient gets to the hospital, where the physician decides whether to continue with or stop CPR. A copy of the forms in the Green Sleeve should be given to your agent, family, and healthcare provider.

The Green Sleeve contains Advanced Care Planning documents and is the property of the patient. Before it is issued there is a discussion between medical staff and the patient called “Conversations that matter: Goals of Care." I will cut and paste some of the document provided by Alberta Health Services. There are three levels of care:

“Medical Care (M) – Medical tests and interventions are used to cure or manage an illness as well as possible but don’t use resuscitative or life support measures. This is appropriate when resuscitative and life support measures won’t work or when the person chooses not to have these treatments. Medical care can be given in many locations, depending on the person’s wishes and values as well as if it’s appropriate medically.

Resuscitative Care (R) – The focus is to extend or preserve life using any medical or surgical means. This includes, if needed, resuscitation and admission to the intensive care unit. Talk to your healthcare team about which Goal of Care designation best reflects your health circumstances and your wishes and values.

Comfort Care (C) – The focus of care is to provide comfort to ease a person’s symptoms without trying to control the underlying illness. This is for people who have a life-limiting illness, when treatments can’t influence the course of that illness. This care can be given in any setting.

Within these three main approaches to care (Resuscitation, Medical, and Comfort Care), there are sub-categories. These are used to further define and communicate your Goals of Care designation to healthcare providers.” (AHS website, April 11, 2017)

I would highly recommend that you access the Advanced Care Planning website devised by Alberta Health Care, the provincial (as opposed to federal) government department that is responsible for providing (free) health care to Albertans, and gives wonderful information about Advanced Care Planning. It is available in eight different languages including Punjabi, Vietnamese and Chinese.

https://myhealth.alberta.ca/Alberta/Pages/advance-care-planning-conversation-matters.aspx

In the “Other Places to get help” click on PREPARE. PREPARE is a program helps you make medical decisions for yourself and others, talk with your doctors, and get the medical care that’s right for you.

I hope this posting is of some help to all of you. Even though the AHS website is Canadian and there may be some differences, the basic concept remains the same.
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Thanks, all. I spoke to our elder lawyer, and it turns out this was all taken care of after all.
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Although I am responding Xinabess’s thread about DNR I see that the situation has been resolved. It is not an easy decision but an important one, nevertheless. I ask your patience while I share my experience with CPR, both as a recipient and as a Nurse CRP Instructor.

First may I compare my situation with that of a young man called Ben. Although there was more than 30 years between our respective experiences but very similar circumstances, there was a huge difference in the outcome. We both, at 14 years of age, went underwater in a swimming pool. In my case, the pool was almost empty, someone realized immediately that I was in trouble, got me out of the pool and started CPR. Within 10 minutes I was sitting up asking what happened.

Ben was not so fortunate. He got caught under a piece of pool equipment and it was only when the pool was cleared that he was found. CPR was started immediately and, to the relief of everyone, his heart started to beat and he started to breathe on his own. It was a municipal pool and he got several million dollars in compensation—which is just as well— because he will need every cent he can get for his caregiving needs—now a healthy 19-year-old –but with a severe brain damage because his brain was deprived of oxygen too long. He can no longer walk, talk or see. He is confined to his bed or the chance of a change in his environment in his wheelchair. His lifespan is largely unaffected by his brain injury and he could, barring accident or injury, live for another 40-50 years.

As a CPR instructor, I taught my students that the first four minutes were imperative. After that the chances of a successful resuscitation diminished. Some institutions have an unspoken agreement to have a “slow code” i.e. no breakneck rush to get to the patient to start CPR but, instead, a “time wasting” period to delay the start of CRP, thus increasing the chances of a negative outcome. I, personally, believe that this is totally unethical but usually happens when the person who needs CPR should have had a DNR order in place—but didn’t. However, a slow code goes against the wishes of the patient/family and we, as health caregivers, need to respect those wishes no matter how much we disagree.

Incidentally, other than me, and although I am aware that it does happen,I have never attended a successful resuscitation--on young or old.

This post is getting a bit long so I will add another sharing what we do about resuscitation in Alberta, Canada.
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I agree with Dontask. if you have to jump through hoops to get her to sign a DNR something is wrong even if she doesn't want to sign it. Please don't have someone talk to her who is prejudiced against life and please don't have a talk with her to talk her into a DNR. She wants to live. Do everything you can to make her quality of life the best it can be given whatever state of her existence. Please be observant and creative to add to the time of her life.
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For instructions at home and away, you should look into signing a MOLST (or POLST): Medical (or Physician's) Orders for Life-Sustaining Treatment. It's not something you or a lawyer can do. She will need to have the counseling from a medical professional, but it is something that she signs herself. (My understand is that a DNR order is different: it is signed by a doctor and placed in her chart, typically in a hospital.)

She has previously told you and perhaps others differently (rejected her DNR), so you may have difficulty now in overriding her decisions without petitioning for guardianship, which you should really try to avoid. Remember that as her health care proxy, you are supposed to do what she would want to do herself. If you don't know that, you are supposed to use substituted judgment: knowing what you know about her, what she has said in the past, her values, you are supposed to step into her shoes and do what you THINK she would want you to do. This may be different than what you yourself would do if YOU were in that situation.

Going through the process of signing a MOLST should make her wishes clear, and take the burden off of you.
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I just went through a process to make sure I would not be brought back if I was very ill. I want to die in peace when the time comes. I was offered a form to fill out. However, my doctor said sometimes DNR's are open to interpretation by the doctor on hand. She said the best way is to have family or other legally appointed persons tell the doctors what they should and should not do. In other words, humans SPEAKING carry more weight than forms. Please discuss this with your doctor. But as a daughter, I think your wishes and instructions should be followed.
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I'm sorry I didn't read the question vary carefully and I should of put my glasses on. It's true every facility has you sign or not sign for a DNR they got to the point they didn't ask me or the family they asked him. Of course he said he wanted it. But than we must have different dr cuz they kept pushing for the DNR so he finally agreed to it. I'm sorry I didn't read yours better I pray your doctors come to there senses and talk to you and your family or someone like hospice or palliative care gets involved to help explain. I'm sorry again for not putting on my glasses I pray the best for you
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