Ferryhill man speaks out about insensitive approach

A GRIEVING husband says he is convinced that a Do Not Resuscitate note placed on his wife’s medical file accelerated her death.

Norman Marshall, 68, from Ferryhill, County Durham, said he wants to speak out against what he describs as the "insensitive" use of DNAR (Do Not Attempt Resuscitation) notes in NHS hospitals.

Despite Department of Health guidance which stresses that patients and their families should be consulted when doctors are considering imposing a DNAR order, Mr Marshall said his seriously ill wife, Jean, was approached without any other family member being present.

"My wife, Jean, was in Darlington Memorial Hospital in December 2011 as a result of her recurring breast cancer," said Mr Marshall.

"She was receiving treatment and although not well she was able to chat with me during my twice daily visits and on occasions was very upbeat.

"One morning, while she was alone, my wife was handed a DNAR order by one of the doctors who asked her to read the information."

When Mr Marshall arrived for afternoon visiting he said his wife was "in a state of terror and panic".

From that day, Mr Marshall said her state of mind deteriorated "significantly" and she began having "continuous panic attacks" which she had not experienced before being handed the DNAR note.

Mr Marshall said his wife continued to suffer panic attacks until she died at home on January 2, 2012.

Mr Marshall was moved to contact The Northern Echo after reading the recent story of Alan Cargill, a 69 year old cancer patient who was also approached by a doctor and issued with a DNAR while he was on his own, on a ward in Darlington Memorial Hospital.

Mr Cargill, from West Cornforth, County Durham, told The Northern Echo that the experience was frightening.

he said: "He terrified me, to be truthful. It is bad craic for something like that to happen when you are that ill."

Mr Cargill, who has now left hospital, was particularly concerned that the conversation took place without any other member of his family being present.

After taking legal advice, Mr Cargill, told the hospital he did not want to order to apply to him and tore up the document.

Despite NHS guidelines about the issuing of DNAR notices Mr Marshall said the family were not invited to be present when the DNAR order was issued.

"As far as my daughter and I are concerned, that morning played a significant role in the death of my wife," he said.

He said he hoped that the "distressing situation" his wife experienced would not repeated with any other patient at the County Durham and Darlington hospital trust.

Katherine Murphy, chief executive of the Patients Association told The Northern Echo: "There have been far too many cases where healthcare professionals have failed to facilitate proper conversations with relatives and patients about how, when and why a DNAR order may be used. "

She said hospitals need to ensure there are open discussions about end-of-life care involving patients and relatives.

No-one from County Durham and Darlington NHS Foundation Trust was available to comment.

Comments (11)

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8:56am Mon 18 Feb 13

jandarlo says...

a DNR was placed on my aunt during a recent stay in darlington memorial hospital. as a family we were vehemently against this and i informed them if they made no attempt to rescusitate my aunt we would prosecute them for murder. i tried to physically remove the DNR sheet of paper from her file and was told i couldnt as it was a legal document. we were bullied by medical staff and told we didnt 'understand' the procedures. the DNR was not removed and it stood for the length of her stay. i insisted they wrote in her notes that i was against the DNR. we literally begged for her life. it is legalised euthanasia of an aging/sick population. my aunt was lucky and has now came home. i am sorry for your loss Mr Marshall.
a DNR was placed on my aunt during a recent stay in darlington memorial hospital. as a family we were vehemently against this and i informed them if they made no attempt to rescusitate my aunt we would prosecute them for murder. i tried to physically remove the DNR sheet of paper from her file and was told i couldnt as it was a legal document. we were bullied by medical staff and told we didnt 'understand' the procedures. the DNR was not removed and it stood for the length of her stay. i insisted they wrote in her notes that i was against the DNR. we literally begged for her life. it is legalised euthanasia of an aging/sick population. my aunt was lucky and has now came home. i am sorry for your loss Mr Marshall. jandarlo

10:01am Mon 18 Feb 13

thehogman says...

I would suggest that when people are expected to die because of their poor health along with no chance of a useful or extended recovery then prolonging the coming death is a misguided waste of energy; it ties up resources and prolongs suffering.
It is selfish of a family and the patient to want to seen to be suffering or to watch them suffering, hanging on by one's finger tips is only putting off the inevitable.
DNR is a useful and sensible way forward; at the end of the day the quality of life should be considered, in many cases the end is a blessing; grieve but by thankful their suffering is over
I would suggest that when people are expected to die because of their poor health along with no chance of a useful or extended recovery then prolonging the coming death is a misguided waste of energy; it ties up resources and prolongs suffering. It is selfish of a family and the patient to want to seen to be suffering or to watch them suffering, hanging on by one's finger tips is only putting off the inevitable. DNR is a useful and sensible way forward; at the end of the day the quality of life should be considered, in many cases the end is a blessing; grieve but by thankful their suffering is over thehogman

10:12am Mon 18 Feb 13

pager11 says...

An elderly friend of mine was in the memorial last year in ward 43, she was admitted from the care home where she lives, she was diagnosed with a water infection, her elderly brother was called to come to the hospital where he was told to expect the worst, as she had a water infection she was obviously confused and hallucinating with the toxins, they had a "nil by mouth" above her bed. When she was visited by friends they asked why this was and were just ignored, they even pointed out that she had only came in with an water infection, after several days we decided to bring in small rice pudding, custard and fruit drinks with vitamins in. The difference from going into the hospital and being attended to by friends was remarkable. I have no doubt whatsoever our friend would not be here now if it were not for the team of people who attended her. It is an absolute disgrace, patients care should come before targets and money!
An elderly friend of mine was in the memorial last year in ward 43, she was admitted from the care home where she lives, she was diagnosed with a water infection, her elderly brother was called to come to the hospital where he was told to expect the worst, as she had a water infection she was obviously confused and hallucinating with the toxins, they had a "nil by mouth" above her bed. When she was visited by friends they asked why this was and were just ignored, they even pointed out that she had only came in with an water infection, after several days we decided to bring in small rice pudding, custard and fruit drinks with vitamins in. The difference from going into the hospital and being attended to by friends was remarkable. I have no doubt whatsoever our friend would not be here now if it were not for the team of people who attended her. It is an absolute disgrace, patients care should come before targets and money! pager11

10:23am Mon 18 Feb 13

smokin says...

this happens in too many hospitals and in home care
I called in to see my mum one day to be told by the home carer that a DNAR was in place
she was 92 and wouldn't have a clue what this was about and if anything happened while I was there I would have to watch my mum die and not be able to help her without the fear of prosecution
disgusting
needless to say my visits were cut short because of this as I didn't want anything to happen to her while I was there and not to be able to do anything
to help these things scare the hell out of me
this happens in too many hospitals and in home care I called in to see my mum one day to be told by the home carer that a DNAR was in place she was 92 and wouldn't have a clue what this was about and if anything happened while I was there I would have to watch my mum die and not be able to help her without the fear of prosecution disgusting needless to say my visits were cut short because of this as I didn't want anything to happen to her while I was there and not to be able to do anything to help these things scare the hell out of me smokin

11:53am Mon 18 Feb 13

Ally F says...

This is a difficult one, which I would not normally comment on due to the personal nature of the story, but I found myself in a very similar position with my late wife. I honestly feel that, for someone with a life limiting terminal illness such as cancer, once all treatment options are exhausted and they are in palliative care, nature should take its course. In my case, similar to Mr Marshall, my wife was able to come home for her final few weeks. She was comfortable and not in pain when she died, aged 27.

My wife was aware of her illness and the seriousness of it - she had lived with it for nearly 10 years. Towards the end of her life it's not something she wished to discuss much, so we didn't. We both knew that the medical professionals had reached the end of the road. I'm sure my wife knew she was dying however, her physical condition by then obvious to all to see. It would not have been in her interest to attempt any resuscitation. I believe that once no medical chance of recovery or long-term improvement remains, resuscitation is not in the patient's interest.

Of course the definition of 'life-limiting' for someone in their twenties with terminal cancer is relatively clear. For someone old and infirm in hospital it is not so clear. There are difficult moral and ethical decisions hospitals have to make every day, and I do not for one minute believe that cost is an influential factor. Whose decision is it? Provided the patient is able to make an informed choice, it's their decision. The hospital is making choices in the interest of the patient, not the patient's family. No-one wants to lose a loved one, and the natural and entirely understandable stance of close family will be to attempt resuscitation however futile.
This is a difficult one, which I would not normally comment on due to the personal nature of the story, but I found myself in a very similar position with my late wife. I honestly feel that, for someone with a life limiting terminal illness such as cancer, once all treatment options are exhausted and they are in palliative care, nature should take its course. In my case, similar to Mr Marshall, my wife was able to come home for her final few weeks. She was comfortable and not in pain when she died, aged 27. My wife was aware of her illness and the seriousness of it - she had lived with it for nearly 10 years. Towards the end of her life it's not something she wished to discuss much, so we didn't. We both knew that the medical professionals had reached the end of the road. I'm sure my wife knew she was dying however, her physical condition by then obvious to all to see. It would not have been in her interest to attempt any resuscitation. I believe that once no medical chance of recovery or long-term improvement remains, resuscitation is not in the patient's interest. Of course the definition of 'life-limiting' for someone in their twenties with terminal cancer is relatively clear. For someone old and infirm in hospital it is not so clear. There are difficult moral and ethical decisions hospitals have to make every day, and I do not for one minute believe that cost is an influential factor. Whose decision is it? Provided the patient is able to make an informed choice, it's their decision. The hospital is making choices in the interest of the patient, not the patient's family. No-one wants to lose a loved one, and the natural and entirely understandable stance of close family will be to attempt resuscitation however futile. Ally F

8:22pm Mon 18 Feb 13

maur1 says...

well i say ask the family ,and ally so sorry xx your wife was no age at all . we dont want to see our loved ones suffer but at same time we dont want to be given up on . god bless you ally hope in time all your good memories shine through and your able to move on
well i say ask the family ,and ally so sorry xx your wife was no age at all . we dont want to see our loved ones suffer but at same time we dont want to be given up on . god bless you ally hope in time all your good memories shine through and your able to move on maur1

8:33pm Mon 18 Feb 13

peanutjones says...

A DNAR order is not a termination of life, nor euthanasia or anything like it. It means exactly what it says - An attempt at Cardio-pulmonary resuscitation is not to be attempted. It does not mean that active treatment is to cease. If the person's heart stops then the horrendous process of resuscitation is not to commence. It really is horrific too. Chest compressions, 360 joules of electricity applied - not to be taken lightly.
A DNAR order is not a termination of life, nor euthanasia or anything like it. It means exactly what it says - An attempt at Cardio-pulmonary resuscitation is not to be attempted. It does not mean that active treatment is to cease. If the person's heart stops then the horrendous process of resuscitation is not to commence. It really is horrific too. Chest compressions, 360 joules of electricity applied - not to be taken lightly. peanutjones

9:54pm Mon 18 Feb 13

maur1 says...

my feeeling is anyones life is important
i think nhs should do all no mattter what its someones life
my feeeling is anyones life is important i think nhs should do all no mattter what its someones life maur1

8:24am Tue 19 Feb 13

simmo707 says...

BROKEN BRITAIN UNDER TORIES –AMERICAN INFLUENCE/WELFARE/HE
ALTH/WARS/EMPLOYMENT

The American dream - that’s what the USA population are told to believe in because they cannot believe in anything else and what their Politicians say and do influences the British Establishment – much to our detriment .What has it got to do with America about our membership of the EU .How many wars have we been involved in concerning the Yanks .We have only just finished paying them back for WW11 – Allies ,we paid dearly for their involvement .Where did we get Welfare Reform from UNUM American not fit for purpose insurance con .Successive Governments in the UK haven’t a brain between them they have followed the American Model – much to the British Public cost .We the British Public have not been taken in by the Yanks but those in charge of us have and we have to pay for it .”It’s not what Britain can do for you but how you can line Government pockets “ www.brokenbritainund
ertories.com
BROKEN BRITAIN UNDER TORIES –AMERICAN INFLUENCE/WELFARE/HE ALTH/WARS/EMPLOYMENT The American dream - that’s what the USA population are told to believe in because they cannot believe in anything else and what their Politicians say and do influences the British Establishment – much to our detriment .What has it got to do with America about our membership of the EU .How many wars have we been involved in concerning the Yanks .We have only just finished paying them back for WW11 – Allies ,we paid dearly for their involvement .Where did we get Welfare Reform from UNUM American not fit for purpose insurance con .Successive Governments in the UK haven’t a brain between them they have followed the American Model – much to the British Public cost .We the British Public have not been taken in by the Yanks but those in charge of us have and we have to pay for it .”It’s not what Britain can do for you but how you can line Government pockets “ www.brokenbritainund ertories.com simmo707

10:25am Tue 19 Feb 13

Homshaw1 says...

All I know is I don't want to be admitted to hospital - It's scary.


There must be lots of older people terrified of old folks homes and hospitals

"Do not resusitate notices" clearly visible to all and sundry is insensitive to say the least
All I know is I don't want to be admitted to hospital - It's scary. There must be lots of older people terrified of old folks homes and hospitals "Do not resusitate notices" clearly visible to all and sundry is insensitive to say the least Homshaw1

12:46pm Tue 19 Feb 13

ace38 says...

It is easy to say "let them go. They are very old" when it is not you or a loved one. As Scrooge said in `A Christmas Carol`, the surplus population. My Mother was seriously ill abroad aged 81 at the time, but she made a full recovery. The hospital staff were excellent. I am convinced that she would not have survived if she had been admitted to a hospital in the UK. It is time for an overhaul of procedures in the NHS. Management and staff are treating patients with the same disregard that some totalitarian states treat their people.
It is easy to say "let them go. They are very old" when it is not you or a loved one. As Scrooge said in `A Christmas Carol`, the surplus population. My Mother was seriously ill abroad aged 81 at the time, but she made a full recovery. The hospital staff were excellent. I am convinced that she would not have survived if she had been admitted to a hospital in the UK. It is time for an overhaul of procedures in the NHS. Management and staff are treating patients with the same disregard that some totalitarian states treat their people. ace38

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