My mother has a DNR. If she has a stroke or heart attack, do I still call 911?

I faced same situation with my husband who had dementia, I was instructed to call 911 and relay DNR order to first responders

I am retired now, but in my former profession I and my staff were required to maintain current CPR certification at all times. This requirement entailed passing numerous (repeated) training sessions over the 40 years I worked. One of the best and most enlightening training experiences, for me, was provided late in my career by a fire department lieutenant and paramedic who stated emphatically at the start of the session that it is a misnomer that persons performing CPR are "saving lives". CPR does not "save lives"; rather, it (chest compressions) assures a level of oxygenation and circulation of the blood, when the heart has already stopped working, between the call to 911 and the arrival of paramedics. That is ALL it does. That said, performing CPR on anyone is traumatic and can result in internal injury including broken bones, e.g., ribs. This is especially true for elderly people who tend to be more fragile and brittle. So, be aware of the very real risks and limitations if you decide to perform CPR against the wishes of an individual with a DNR order. And, in any event, tell the paramedics of the DNR status as soon as they arrive on the scene, because you are responsible for conveying this important information.

Yes please call Hospice for an evaluation. You will be glad you did. If your mom is terminal then make her comfortable. Hospice will assist the family in helping them cope as well. Hospice helps your loved one's journey home with peace & dignity. 

As a nurse, I can tell you that you need someone there to observe and to name the time of death, if your mom is dying but still alive, for example having a heart attack while you are watching. Also, the paramedics can give her pain meds or other treatments that are not life-prolonging to ease her way to heaven. If you would happen to find your mom already gone, I would still call 911 and tell them what has happened, the ambulance will not come, but the police will and possibly the coroner. Someone has to officially declare her dead, and then you can call the funeral home and they will come pick her up right from your house. If it an expected death, usually the police will let you call the funeral home and the coroner won't have to come. Every county can be different depending on what the coroner in that county prefers. As to performing CPR., if someone is a DNR, it is considered assault to do CPR! So don't and don't let anyone else, either. It's not like the movies or TV, where people have CPR and wake up fine, if your mom has a severe stroke or heart attack, you would probably be saving her to be a vegetable, and obviously she didn't want that or she wouldn't have made herself a DNR.
I agree with the previous comment about contacting Hospice to help you with this journey you are on with your mom. They can provide so much support and guidance for you and also caregiver respite so you can have some time to go do errands or other things while they are at your house taking care of your mom.

I find it tough in my case because while mom has dnr - when she has been having chest pain or heart attack she calls 911 and later tells me how terrified she was and how she thought she was not going to make it and thank God I was there...so it is confusing at times even with a directive.

My husband and I both have DNR's. Recently, he had a severe convulsion that left him unconscious; we were in the car, so I drove him to the hospital. It turned out that he had pneumonia with sepsis...no cough, no fever, didn't complain about feeling bad. He was life flighted to the nearest Level I trauma center; I signed the paperwork for him to be treated. I drove to the center...it took me 3 hours to get there. When I got to ICU and he was intubated. I was shocked! At that point, I told the hospital staff he had a DNR.

He was intubated for 4 days; kidneys failing with a coffee colored output; swelling all over; his arms swelled up and turned dark; brown liquid was suctioned out of his lungs. I did not think he would survive (he's 72, has had a hemorrhagic stroke and has vascular dementia). He was in an induced coma and awakened on the 4th day and moved to the "floor".

My husband is in the moderate stage of vascular dementia. After he survived the sepsis and woke up, his memory was much worse and he required assistance with everything...going to the bathroom, eating, bathing, brushing his teeth. I was heartbroken! When we left the hospital, he was still having liver problems and I had to drive home...12 hours (we were on vacation when he got ill and our A/C went out in the pickup and we were in West Texas, so I decided to drive in the night when it was cooler). When we got home, he didn't recognize our home...he was just so confused.

Now, two months later...his liver problems are resolving...some of his medication was causing the problem and the elevated ammonia from the liver issues was causing the confusion. He is almost back to his pre-illness normal and titrated back to the lowest dose of medicine that was causing the liver problem. Next week he will be completely off and I hope he will be back to "his" normal.

As I look back at the sequence of events, I'm glad I did not think to give the emergency personnel his DNR before he was life flighted (he had hypoxic respiratory failure on the flight to the Level I center). He is back to the place where he can feed himself; take his shower; dress himself; go to the bathroom by himself. He is more dependent in some ways, but I don't regret that he survived. He is still able to remember our past and he can engage in conversation again...he may not remember that he just ate lunch; he may not remember where the refrigerator is, or what month it is, but he is still my companion and husband of 42 years and we can still laugh together.

For me, the DNR means that he should not be resuscitated if there is significant brain damage, organ damage, or bodily damage that would leave him unable to enjoy life. For he is now, he is happy with the life he has. When he was still unconscious after I informed them of the DNR, I felt guilty for days. If I were faced with that decision again, I would not give it to them until I was informed that nothing else could be done and he would be in a vegetative state or helpless and dependent on massive amounts of pain medication. So, I guess it boils down to "his" mental consciousness. When he can no longer enjoy life, there will be no need to resuscitate him.

I hope sharing my experience has helped. It is an awesome responsibility and I think it is essential to consult with the doctor that is treating the individual before making the decision to give them the DNR. I would hate to think of the guilt you might feel throughout your life if you take the whole burden on yourself....just my opinion...May God bless you and lead you through this difficult situation.

If you had "advanced dementia, with minimal motor function" and had signed a DNR , would you think it would be "Inhumane" for your children to honor your wishes?
Probably not!

No, a DNR does not mean you don't call 911, unless you are a trained medical professional you can't possibly know whether someone is stoking out or having a heart attack that isn't survivable or is suffering from some other ailment. And if she has a stroke etc and survives they will be better able to assess what her new limitations are and advise you about her care going forward, rather that you being stressed and without a concrete diagnosis.
Better yet is to see if she qualifies for hospice or palliative care services, which usually includes a 24/7 number to call for immediate assistance, as well as prepares the paperwork needed for an expected death in the home.

A DNR does not mean, do CPR and a shock and if that doesn't work, stop. I ditto those that know a DNR means, "do not resuscitate"...do not do CPR on me....do not intubate me..... If that decision was made when someone was of sound mind, honor their wishes! Advanced alzheimer's with little motor function? honor her wishes. In my state, a DNR form is placed in a universal location (refrigerator) and if EMS (911) is called, they know to look for it there. If they see it, they will not encourage CPR. My husband has advanced Alzheimer's and ALS (losing motor function). He has a DNR so I understand what you are going through but again, I encourage you to honor her wishes, not try to second guess them.

This was just discussed in another thread. The DNR is for emergency personnel and medical staff. It was mentioned in the other thread, by not calling 911 could be held against you too. A stroke is not always life threatening. The sooner you get the person to the hosptial the more likely they will survive. Same with a heart attack. What a DNR is for is that no extreme measures will be taken to keep them alive. Such as CPR if the heart stops or intubation. Putting in a feeding tube. Once they are in, very hard to have them taken out. I have a NJ one in my hand. It says:

Symptom Treatment only: For comfort only.
No artificial nutrition
Do Not resuscitate
Do not intubate

It comes down to if they stop breathing or heart is stopped then that's it. I think otherwise, you need to call 911. You should have the DNR ready for emergency personnel.

I would not try to revive her. If she is old, you could break ribs trying to keep her heart working. I would call 911 so they could take her to the hospital. Have the DNR ready to show them. They will know what to do.

It is not inhumane to let someone die naturally. It can be more inhumane to try to keep them alive when they are suffering. It was a thought that I had when I had a rabbit that was suffering greatly. I realized that keeping him alive had become more about me than about him. I hope if I ever get to that point that whoever is in charge will let me cross over to the other side. Death is something that we all have to go through one day.

Administering CPR is the opposite of what a DNR (do not resuscitate) means. Assuming your mom was of sound mind when she implemented the DNR, she does NOT want to be revived. My mom had a DNR and died at home. In my case, mom died while I was in the other room.

Have you considered bringing in hospice? They can help you get comfortable with the idea of her passing and give you help in understanding where she is in the process. I brought in hospice for my mom (she didn't have Alzheimers) but was definitely going downhill fast. She died one week after I started with them. They predicted the day she would die and I was able to spend the entire day with her from 10 AM until I found her at 11:35 PM. I had gone out to lie down and when I came back in, she was gone. She had been semi-comatose for several days. I got to talk to her, play music for her, hold her hand, and say what I needed to say in that final day.

I hope you can honor your mom's wishes and be comfortable with the idea that a peaceful passing (without doing CPR or calling 911) is a way to honor your mom and her wishes. Hugs...

nikawriter, this is a tough decision. If you don't do anything it would haunt you more so then if you tried to give Mom CPR.

If it was me and there was a DNR, I think I would still give CPR a try, and if it doesn't help at least you know you gave it your best shot. Also a lot depends on how long she has been without oxygen. If she is starting to feel cold to the touch, then no CPR. I probably would still call 911 so they can assess the situation.