It's naive to think DNRs are only relevent to cardiac arrest situations.

It’s worth watching

Clare Craig

from 14 mins into Neil Oliver’s show on GB News the other evening talking about the harrowing testimony given to the Scottish covid Inquiry:

Clare makes a really important point - which is this:

Those with DNRs were being denied admission by many hospitals, so being denied treatment generally.

But I think there’s another - more important - point to be made, which I tweeted here.

The point is this:

For those in hopsital, the existence of a DNR has much broader implications for the way patients are treated than in relation to the response to a cardiac arrest.

I was pleased to see John Campell making this point in a recent video:

This is what John said from around the 2-minute mark (my emphasis):

There's another problem here with DNRs.

Now “Do Not Resuscitate” applies to a particular situation where someone basically goes into cardiac arrest or respiratory arrest.

It's a situation I've dealt with many many times, the patient's heart will typically fibrillate, there's no effective cardiac output and shortly after that the patient will become unconscious and shortly after that they will stop breathing.

There may be agonal respirations for a period of time…. and that needs.…we can give cardiopulmonary resuscitation…to maintain the circulation.

But you're only going to get those patients back by using defibrillation to give them the shock to take the ventricular fibrillation back to sinus rhythm.

That's technically what this means, but many nurses interpret Do Not Attempt Resuscitation orders as well….basically we've gone on to paliative care, we've basically given up on saving this patient's life; this is completely wrong but this is the way it's often interpreted.

My experience of this again is extensive, having over 40 years experience working as a nurse and with nurses.

So it's often a sign that it's time to sort of give up….but it shouldn't be.

It's quite specific to resuscitation, this doesn't mean we don't give these patients antibiotics we should do this….doesn't mean to say we don't give patient subcutaneous and intravenous fluids, we should do all these things, should still carry on.

It's just in the event of a cardiac arrest or respiratory arrest, there'd be no what we call heroic interventions, and the principle here is we should not fight for life in a way which is officious… you should not hang on to life in an officious manner; that's the principle, and it's one that I agree with, but it's often misinterpreted.

In this video he also covers testimony given from someone with a power of attorney who discovered that her loved one had had a DNR order put in place against her¹ express wishes.

It’s good to see the Scottish Inquiry gaining some further airtime. Do subscribe to Dave’s substack for further updates.

Finally, if you want to read about a recent historical example in which circumstances blurred the ethical boundaries being observed by healthcare workers, do familiarise yourselves with the fascinating case of the deaths in the New Orleans Memorial Hospital after Hurricane Katrina in 2006:

Ethical boundaries in medical decision-making can be blurred by circumstances

1. ie against the express wishes of the person giving the testimony and holding the power of attorney.