Changed DNR, what options do we have?

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Changed DNR, what options do we have?

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Hi. My father in law is in the end stages of Alzheimers and was given weeks to a few months left to live. He had a DNR in place but my mother in law withdrew it and now wants full life saving efforts performed on him. My question is, what options does my husband's family have? It puts myself, him and his brother in a terrible position as we are all EMT's and a nurse and we are required by law to call EMS and initiate life saving efforts on him. What do you recommend and is there anything that we can put in place to not have that happen? My mother in law will not change her mind. I hate the thought of him not being able to pass away peacefully.

Do Not Resuscitate (DNR) Elder Law End of Life Medical Care

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Theres not much they can do other than talk to their mother and try to change her mind. Surely with their job experience, they can adequately explain to her what the downside to life saving measures is since they’ve seen it firsthand. Other than that, she’s his wife and his first next of kin. There’s nothing you can put in place that changes that.

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I would contact a certified elder law attorney, I don't believe that anyone can change your end of life wishes.

That's the whole points of having these documents. POA doesn't give you the right to change what a person requests when they are of sound mind. You can only honor their wishes and act on their behalf in their best interests.

See an attorney.

I am sorry that your family is facing this. Not like the long goodbye isn't hard enough.

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I don't think there's anything the family can do unless someone other than your MIL is the healthcare POA for your FIL. I would get an elder care atty involved.

I think your best bet is to try to convince her to reconsider. Explain to her how painful resuscitation may be... broken ribs if cpr, electric shock to restart heart, possible intubation, etc. As EMTs you know the consequences. I assume he's under hospice care. If not, why not? They will provide him with a peaceful, painless, comfortable death. Would she want to harm him to extend a non viable life? I know you can't tell her this, but it's very selfish on her part.

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I don't mean to sound cold, but if he needs to have CPR done, have her watch it. This has worked for us in the hospital when pts have needed to be coded and the family was in the room. Most families have this TV happy notion that it will save a life with no harm done,, instead of the broken ribs, crushed sternums, punctured lungs , etc that are the reality. May families seeing the reality are then able to go along with the pts DNr wishes.

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I have said in previous posts..CPR works great on TV and or someone young enough to recover from the broken ribs, broken sternum and most likely the pneumonia that will come due to decreased lung function during healing.
Even as "healthy" as I am I can not imagine the pain that that would cause.

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Hopefully he will pass in his sleep and there won't be the opportunity to resuscitate. This must be so hard for you all. I imagine (actually, I hope!) there is a legal recourse for the family if someone tries to override the final wishes of the patient. But practically speaking, you have to live with her after he passes away. She might feel like she let him down by not doing everything she could to keep him. And whether someone resuscitates him or not- he's going to go eventually.

Is there hospice involved? I found them to be excellent listeners. Maybe they could help change her mind.

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Thanks, Hospice is involved. It took a lot to get them in though. She canceled them twice before his sister finally got them to go back and stay.

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How about looking up the videos on line of Dr. Atul Gawande entitled, "Being Mortal." His book of the same name is fantasic, though it does cover more than the very end of life. It's something to really consider when making end of life choices. The video is very good as well. Nothing graphic, but confronts the reality of our end.

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Is MIL competent to make those kinds of decisions? Does FIL have an Advance Medical Directive? I agree about seeking a legal opinion for your options. To make an end stage dementia patient endure that kind of thing, when he cannot survive, lets me know that something is not right with her. In the meantime, I’d insist that she be present anytime that I was in his presence.

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Perhaps hospice can talk to your mother n law and get her to change her mind? He’s at the end of life. He should be able to die peacefully. Apparently people can change their minds but I thought once they signed a DNR that was it. My mother signed a DNR and she went in the hospital at 95 1/2 years old and is competent. They put a DNR in big red letters on her wrist when she went on for swelling of her feet and legs. She demanded they take it off and that she changed her mind. They told her No at the hospital. She signed it. That’s it. They told her they could put it on her ankle if it bothered her on her list. She said no. Never mind. I’ll wear it on my wrist.

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Elaine, one can revoke the DNR. She needs to notify her doctor. Google "revoking DNR".

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I wonder if some one person can have a quiet conversation with mom....

"Mom, what do you hope to accomplish by changing dad to full code?"

She needs to talk out what her thinking is on this to see if she understands that he is dying. I'm wondering if she's got some cognitive issues that have gone unnoticed.

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I don't think cognitive issues come into play here.
The issue here is her heart.
This is a man she has been married to for many years. Her husband, her soulmate, her love. I'm sure one day she thinks yes to the DNR, so her love will not have to suffer any more. Another day, she thinks, no, I want him here with me, one more day.
I think this will just play out for the better. She may feel guilty signing the DNR, but when the time does come, the doctors etc, will do the right thing. So she won't have to live with the guilt about the DNR. She will at least know & feel that she did everything possible for her husband.

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DNR/POLST... Hospice on board yet? If so, hospice needs to talk with mom and family discuss the situation and what happens. What kind of measures will be taken if and when the pain and suffering begins.

No invasive measures were on DNR, no morphine drips, no IV's. That was no fun. Thankfully no intubating the patient either.
They had strict instructions-DNR- not to call the doctor until you actually know he is gone. He went peacefully.
He was still in home when a family member inlaw was asking who wanted his computer... ??? He is still inside the house, and you are asking who wants the computer? seriously? And a few days later, someone was coming to pickup the washer n dryer because inlaw sold that, and his clothes were still in the wash. :(

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Barb, this has happened before with my Mother. She sits down with the primary care physician, and the doctor talks her into signing the DNR, so my Mother signs it understanding fully what she has signed, and then when she gets into the hospital, she panics and says no I don't want to die!! Take the DNR off!! We've been through this a couple of times.

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Your father put the DNR in place and his wishes should be expected. I was shocked when my mother chose DNR but when the physical effects of resuscitation were explained to me then I supported her in her choice. Perhaps the family could explain to your mom why it is not in the best interest of elderly people to go through resuscitation, she might change her mind. I assume your father is no longer competent and as next of kin she can legally choose for him. Perhaps if she knows the specific injuries he could incur, she would not want him to suffer.

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Years ago my husband and I completed DNRs for both of us and provided them to our health care professionals. We did this to avoid making emotional decisions. Our DNR has to have the physicians recommendation in reference to our current health at that time. I can see why a spouse should want to destroy the document - because our love is not always rational. Was that the only copy? I wish you and your family ease and comfort as you travel this difficult road.

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What!? Didn’t your father have to sign the DNR? I know my dad did. If he signed it then it’s his wishes. I didn’t know someone else could withdraw it. Can a chaplain from hospice or her pastor, priest, rabbi etc. talk to her about death etc? She is obviously not facing reality of her husband’s condition

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It's her decision obviously and the only thing you can do is realize if someone is going to die, they will die regardless of resuscitative efforts. Just support her and try to all be as kind as possible to each other. Now is not the time for dissension. The most productive thing you can do in this case is not to "win," but for each of you to bend over backward to be as loving, caring, and supportive of each other as possible.

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When I was going through all this with my Husband I said I was being ruled by 2 major organs in my body, my HEAD and my HEART.
While watching him decline over the course of 12 years my Head knew that a POLST was the right thing but my Heart broke a bit anyway.
But to want him to continue as he was was selfish on my part, I knew he would not want to continue to live the way he had been the past several years.
But in the end it does not matter..we will die. Cold hard fact.
But to die in pain due to life "saving" measures seems to compound the pain the rest of the family has to endure as well as the person who is lying there in bed now not just with a broken brain but broken ribs, sternum, and punctured lungs.
(and at this time with visiting restrictions due to COVID19 you will not be able to visit your loved one in the hospital so very good chance you will not be able to be with him when he dies)

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EDUCATE HER. Make sure she understand DNR means STILL TREAT--just no shocking, intubation or chest compressions. My mom was under hospice for two solid years under full code but I still got her in the Emergency Room lots of times and basically used hospice like a clinic to maintain her routine medications and labs. When I rescinded her Hospice, she got a feeding tube put in, and got her back on hospice on discharge -- easy as pie.

DNR MEANS DO EVERYTHING EXCEPT SHOCKING, CHEST COMPRESSIONS AND INTUBATION. Make sure she understands that.

-->each new admission defaults as FULL CODE even with that yellow DNR directive on the chart. DNR has to be written as a new order with EACH ADMISSION. Also, a DNR CAN BE RESCINDED at any time and is never written in stone.

Mom died age 90 with her feeding tube, and it took care of all her needs so she died comfortably. However, it requires a considerable amount of care to keep it patent, clean and free of infection. I never had a problem with it. Ironically Alzheimer's did not kill her. She died of another health ailment so if she were a walkie talkie the same would have happened to her. Mamma had a lot of chronic diseases it surprised even the doctors she lasted that long...but trust me she was a LOT of hard work.

If your mom does not understand what DNR means, that represents poor nursing and medical care.

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Not if you have a DRN done outside the hospital. A DRN outside of the hospital can be copied and used over and over. We have done this and each time a parent goes by ambulance to the hospital a copy goes with them along with a list of current meds and copy of insurance cards.

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I don't know the legality of this as each state is probably different, but there was an episode of Grey's Anatomy dealing with this. The wife had signed a DNR and the hospital absolutely would not stop it even though husband begged. (It was the episode where the distraught husband shot up the hospital.) My mom signed a DNR and I chose not to try to over-ride it. My sister was very angry with me for not doing so. I concur with checking with atty. Sometimes, end of life wishes are included in will.

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The only thing that will trump her desires is the person with a medical POA. If there is not one in place, you need to go along with her wishes.

I would recommend that all of you have talks with her about your "code" experiences. She may not understand how traumatic a code can be. Remind her that a "full code" does not guarantee that he will survive longer.

Usually, big changes like this have to do with fear of loss. She may not be ready to let her husband go and is holding on with everything she has. Talk with her about her concerns about her husband's impending death. Ask her what she would want in her own "passing from life" experience. Ask her what would be her best way of "saying goodbye" to her husband and creating good memories while he is still alive.

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That's a tough situation you face. When my Mom (who passed in January) signed her DNR request in the hospital a couple of years prior, I was surprised but didn't oppose her wishes of course. Felt sad and questioned it in my mind until the doctor explained how wise her decision was and told what he sees in elderly who do not have a DNR- had no idea the ribs are broken and that most have some brain damage result also. He said it is not like what you see on tv with defibrillation! Perhaps your Mom is also not aware and would benefit from a medical professional explaining this to her as well as explaining that other life-saving procedures WILL still be done.

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I was thinking along the same lines as you. The last time my mom went to the hospital we were advised to change the DRN, because my mom was unlikely to survive the CPR. Many do not realize the ribs are broken. The ER doctor said he had yet to see someone in their 90’s recover from CPR and the resulting broken ribs.

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If this is the DNR for emergency services, that was signed by doctor and your FIL, your MIL cannot rescind it.
As another poster wrote, if this is the hospital form, then it was only good for that single admission.
We need more information and you may need to consult with an attorney.

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End of Life Grief Counseling. There may be someone in their area that specializes in this. The hospice agency or an elder law attorney may know someone who your mother-in-law can talk with.

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Is your MIL the only POA on your FIL health initiatives? How has she been handling his progressive decline through Alzheimers? How old is your MIL? and is she showing signs of dementia? I strongly urge you to review the health initiative documents for everyone in the family and go to 5 Wishes for clarification and assistance as to what you may include in your health initiative documents. Now is the time to talk about this issue for yourselves because it is a bit late for your FIL and MIL.

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Slow walk to call dispatch, slow code til crew arrives. Puts you guys in a terrible position.

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'no hystronics' I've also heard. I like slow code better. Slow. Relaxed. What will be will be.

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I can't answer this legally but a doctor and/or attorney can. How did your Mother in law get it away from him. Were there any witnesses? Not sure if this is legal. I agree that this is HIS choice and no matter by what means, legal or not (such as looking the other way when it is his time and NOT calling for support), to allow him to be at peace may be the only way to go. Also check with the local hospitas and the Office on Aging in your county. This is horrible.

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Should something happen between now and sorting out the paperwork, just question her at the time. Do you think he wants to live with a machine breathing for him, given so many drugs he no longer even is aware of his surroundings, possible breaking of chest bones if they have to do cpr type resuscitation.....does she want that sort of life for herself if she was not expected to live? Sometimes people don't really understand what happens to the body when all life saving attempts are made. On the other hand, doctors can usually explain this to someone quite well in the moment. As a last resort, assume it happens and life saving efforts are made. It might give her mind enough time to accept he got really bad, people tried to save him, and now she's ready to let him go. He would pass with her knowing she tried everything. It happens all the time with people who end up in ER from tragic accidents - they are put on ventilator, attempts are 'visible' even though the doctor was pretty well certain it would not work, however the family let go knowing they tried.

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Usually, states require a form to be filled out, and a physician needs to sign it. I wonder what physician would sign a DNR for someone in end stage Alzheimer's. Truly terrible. Perhaps a conversation with his physician is in order. Clearly, she is in denial and needs counseling.

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A regular DNR can't be changed by your MIL and the hospital should have questioned her on it if it was. The original DNR made and signed by your father can only be changed by him, but you should have your attorney check on that in your state.

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He will most likely end up in hospice and the hospice nurses who do not stay at the facility or your home depending-- will probably come after the fact and do what they do which is what they told me they would do as in the case of my mother's passing which was nothing. In the last day(s) the patient usually agitates because the brain is shutting down and so it ends up in the stem of the brain where all normal functions are regulated, and so the body is confused and does not know what is going on and the patient become agitated, and then passes rather quickly-- as in agitated in the afternoon and then passing in the early evening.
So if I were you I would place this all in God's Hands and watch Him take Dad home. I wish you all the best. Get a copy of Elizabeth Kuebler Ross's book. And do the Jesus thing, and forgive your Mom-in-law. ( with Alzheimer's and dementia, you really cannot stop the inevitable. When I last saw my Mom she had a surprised look on her face as she looked into Heaven).

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Imho, a DNR must be signed off by a medical professional - her physician per se. For it to be made null and void would most likely require an attorney.

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