ALREADY a contentious subject, the issue of decision making in applying Do Not Resuscitate (DNR) orders has been raised again, with the Care Quality Commission seeing a massive jump in complaints regarding such orders during the first wave of the pandemic.

Stories have emerged about the blanket application of DNR orders in care homes, particularly if the individual contracted Covid 19. Concerns were also raised that routine care was not provided due to such orders being in place.

DNR orders are tools which if used appropriately and sensitively, and with the input of the patient and their family where possible, will allow a person a dignified and peaceful death.

DNR means just that. So, if a person’s heart or lungs were to stop, they would not be resuscitated. This does not mean that the person is denied basic comforts such as food and drink or interventions to treat a potentially curable illness. It is not a form that denies escalation of treatment.

CPR is a brutal onslaught to the body requiring repeated chest compressions and often the need for inserting a tube into the person’s airway. It is typically led in a military fashion by a senior medical doctor, with a team required to separate themselves from the emotional trauma of the situation in order to perform effectively. It is not something you would wish to witness as a relative, especially if the chances of success are negligible.

About 15-20% of resuscitation attempts are successful, but recognised complications include broken ribs, punctured lungs and lacerations to organs in the abdomen. A prolonged resuscitation attempt, where there has been considerable interruption of the blood supply to the brain, may result in significant irreversible brain damage. Only 1 in 10 survivors are alive a year later.

Resuscitation attempts may be successful more often in children and younger adults, where there is a reversible abnormality.

As healthcare professionals, we are reminded that DNR orders should where possible be discussed with the individual in a sensitive yet open manner.

If a person without a DNR is admitted to hospital as an emergency and you are consulted as next of kin, the medical team are not asking you to make a decision as to whether to resuscitate, but your opinion on what your loved one would want if they are not in a position to express this themselves.