Corona Virus and DNACPR

I’ve seen outrage on social media this week due to GPs saying they are going to be contacting elderly and vulnerable patients to discuss advance care planning and DNACPR.

“They want to kill you”, “our elderly have paid tax all their lives and this is the thanks they get”, “write off the old people just because they are no use any more.”

Your GP is not offering you a DNACPR because they want to finish you off but because they want to save you the pain and indignity of resuscitation when your chance of surviving it is minimal.

I’m going to let you in to a secret number 1. You are no more likely to die because of Corona virus. Do you know why? Because even without Corona virus you are 100% going to die at some point. What the virus has done is act as a global recognition event waking us up to our own mortality and that of those we love.

Let’s take a closer look at what is being suggested.

1. Advance care planning discussion
Discussion about things such as where you would like to be at the end of your life. Who would you want to be around you? How would you like to be treated?

In the current situation, if you were unable to make decisions for yourself, who would know what you would want? If the answer is ‘no one’ then an advance care plan is a valuable document to have prepared. It does not mean that you are more or less likely to die than without one, but that in the event that this is likely that your wishes will be considered fully.

It is a simple document that can be completed online by anyone as a guide for your care.

This is the hot potato. A DNACR means that in the event your heart stops, and you are effectively dead, resuscitation will not be attempted.

Secret number 2 – if you do not have a DNACPR, resuscitation may still not be attempted in the event that the medics caring for you feel it is not in your best interests. A lack of a DNACPR is not a guarantee of resuscitation. 9/10 doctors when asked said they would not want CPR in the event that their heart were to stop.

If we think about the process of resuscitation, this is brutal. It isn’t like Casualty where a handsome doctor half heartedly bounces around on someone’s chest for a couple of minutes. This is the full force of another person being put through your chest 100-120 times every minute. Think about that for a second….

Now let’s say you survive resuscitation and your heart has restarted. You may well have broken ribs if CPR has been done correctly, particularly if you are elderly. You are alive but don’t forget now you also have Corona virus. A trip to hospital for a chest xray is just the start of your adventure (not counting the CPR of course) and what happens next depends on your symptoms.

If you are lucky and you have mild symptoms you might just be isolated in a hospital ward unable to see your family while your heart condition is investigated and you recover from the virus and are allowed home along with any pre-existing conditions you had at the start of this.

If you are unlucky you can add pneumonia to your list of health issues and if there is a ventilator available, you could spend the next days or weeks having air forced into your ever closing lungs and painful broken ribs. More likely with your chances of survival being minimal you will be given palliative care only, to keep you comfortable as you die in your hospital bed, with your family watching on an ipad from their living room.

You can refuse a DNACPR if you fancy taking your chances – no one can force you to have one but I would urge you. If you are elderly, or vulnerable or even if you are not, think about what you would want and talk to those you love about what they would want. Write it down and please don’t give your GP a hard time if they mention advance planning. Thank you!