Experiences of Manitobans Encountering Do Not Resuscitate Orders

Five Manitobans who had direct experiences with DNR Order placement, either for themselves or someone in their immediate family circle, were interviewed for this project. Some of these persons have requested they remain anonymous. It is for this reason that no sources are named.

The Circumstances

The circumstances around the application of a DNR Order varied from:

	having a DNR Order placed on a spouse’s chart without the surrogate’s knowledge;
	having a DNR Order placed on a spouse’s chart without the surrogate’s consent;
	being included in part of a decision-making process to withdraw medical treatment which led to a loved one’s death. This occurred with 2 interviewees;
	being asked to consider placement of a DNR Order on their own medical chart at a time of critical illness.

Knowledge of DNR Order Application

Awareness that a DNR Order had been placed or was a consideration occurred as follows:

	the medical wristband indicator was spotted by someone else who then inquired as to its purpose to medical staff. The DNR Order had already been placed and it was not rescinded at the request of the patient or the surrogate;
	a non-medical staff member felt compelled to tell the family that a DNR Order had been placed on the patient’s chart. The attending physician had not informed or consulted with them regarding the placement. It was not rescinded at the family’s request and is still in existence at the time this report was written;
	information was provided to the family regarding the medical prognosis of a critically ill patient undergoing ever-worsening medical trauma. The family and doctor agreed together to cease treatment and the patient died. This occurred in the cases of 2 interviewees;
	the patient was informed and consulted regarding the possibility of DNR Order placement. The patient refused, but underwent considerable pressure to reconsider. Within the space of several hours 6 different medical personnel approached the patient to review the decision.

Participation in Decision-Making

When asked if they felt their input was a valued part of the decision-making process by medical personnel, the interviewees responded as follows:

	After repeated attempts to have a DNR Order removed, the patient surrogate felt “blacklisted” by the hospital, felt subjected to a media smear campaign fueled by the hospital, and had their own sanity and capabilities questioned publicly in an attempt to have the complaint withdrawn.
	After repeated attempts to have a DNR Order removed, the patient surrogate was excluded from all other decision making regarding aspects of patient care. The patient surrogate was informed that there would be a meeting between themselves and the Chief Medical Officer, but upon arrival discovered the staff psychologist was there instead to conduct a psychiatric assessment of the surrogate (a non-patient.)
	The doctor strongly stated his preference in terms of the withdrawal of care and the family agreed.
	There was a joint decision between family and health care providers regarding the cessation of treatment.
	The patient felt a distinct prejudice due to their disability which influenced the medical staff’s perception of quality of life. When the patient refused the DNR Order placement, a very grim projection of life was presented, including the inevitability of institutionalization, and unendurable pain and suffering. The patient felt hospital staff did not have a strong enough knowledge base of options available for persons with disabilities to live in the community, and also was not ready to accept the medical prognosis. This was met with some resistance, and the patient was asked repeatedly to “be realistic.” The patient now lives in the community and has not experienced the physical hardships nearly to the extent that they were described.

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