In this article, I would provide the lay perspective of what a DNR meant in Thailand. This is because I have read some scary accounts where patients in ER in some hospitals overseas were denied treatments…. just because they have a DNR. These are not treatments like CPR or oxygen intubation, but more of like treatments that can help the patient recover such as IV antiobiotics for infections, phlegm suction when mucus build up causing patient unable to breathe, etc.
Over these few years my mom have been admitted to hospital for a number of times, mostly due to lung related infections. And each time, the doctor would approach me to ask if I agree to a DNR (do not resuscitate). All doctors in Thailand can speak English and they would explain to me clearly what DNR means and the scope of treatment that they would and would not do if I choose to sign it.
They stress clearly that regardless of whether I signed the DNR or not, they would still do all they can to provide comfort care and medication to treat her ailments- stopping only at the 3 clauses that are covered in the DNR.
The doctors explained to me that DNR covers the following scope:
- do not perform CPR or electric pad shocks when the heart fail
- do not intubate with breathing tubes
- do not inject special medication to jolt the heart when the heart rate falls dangerously low
The above life saving procedures are usually being carried out for those who are relatively healthy or would still be able to have what is considered a good quality of life. However the doctors explained to me that based on my mother’s condition, carrying out the procedures would only prolong her life for a short while but causes her a lot of suffering. It is considered kinder to let the patient pass naturally.
They still give me a choice to sign it or not, stating that if I choose not to sign it, they would carry out the procedures.
The first time I was presented with the DNR, I cried non stop as I did not understand it because I did not know my mom’s condition was that serious. But now, I would sign the DNR each time they presented me with it.
What a DNR is NOT
DNR only involve emergercy intervention like CPR, electric shocks, large breathing tubes intubated in the lungs and/or injection to jolt the heart back. In other words, it is emergency procedures administered to immediately bring the patient back to life or put on life support.
DNR, as I understand it and as being practiced here, does NOT mean stopping or denying the patient of the treatment require that could potentially save their life.
For example, my mom often require admission from lung related issues such as pneunomia, bronchitis, and twice due to Covid-19 infection.
The doctors would have her admitted, put in medication via IV, and the nurses would come and do regular phlegm suction to clear the secretions from her lungs and airways. Thankfully, the treatments have been successful and I got to take her home to continue caring for her.
With DNR, it does not mean they do not treat the pneunomia. It does not mean that just because she could no longer swallow (due to dysphagia) that they stop feeding her food. My mom have been fitted with a nasogastric tube (NG) for more than 2 years already.
DNR does not mean denying all forms of treatments
That is my understanding. It does not mean that just because the person have a DNR, medical staff do not perform treatments or give medication that can help the patient recover.
The doctors and nurses have told me that as my mom is now bedridden, she would have the tendency to get lung related infections easily. They would tell me whenever she show certain symptoms ie non stop wheezing, not responsive, fever or changes in secretions (colour and volume that can be seen during phlegm suction)…… I would need to bring her in to have her checked. They would listen to her lung sounds, take her vitals and do a chest Xray. Sometimes when deemed necessary, they would also draw some blood samples to determine if the level of infection. While she has the tendency for recurring infections, they always did what they could to treat her.
But this is quite different from what I read being practiced in some countries if the patient have a DNR…
I have read that some medical team in overseas would decline to treat the pneunomia. Or they would not do phlegm suction when the secretions build up and the patient is literally choking and drowning in their own secretions that they are not able to clear due to certain medical conditions like not able to swallow or cough out the secretions on their own. In these cases, the patient is not terminal and medication and/or suction would be able to save their life.
I think there is something really wrong with this…. because the patient can still be saved. It is not that they patient’s heart stopped or they suddenly not able to breathe due to being in terminal stage. When my mom was a nurse, I remember she told me that as a trained medical professional, they have the obligation to do administer life saving treatment to anyone who come into the government owned hospitals, regardless of caste, race, and if they have money to pay or not.
Sadly, it seemed not to be the practice today. Or perhaps, have some countries include the scope in a DNR?