Do Not Attempt Resuscitation

The community nurse came to see us yesterday and while here gave us a DNAR form; "as agreed" she said as she handed it to Mum. DNAR stands for 'Do Not Attempt Resuscitation'. It only refers to Cardio Pulmonary Resuscitation (hereafter CPR), not any other continuing treatments which remain in place. Basically it removes the obligation of any visiting healthcare official to perform CPR on Dad if his heart or breathing stop as a result of the progress of the melanoma. It is written and signed by Dad's doctor. Mum and i both believe that when faced with this situation, it would in fact be kinder to let Dad go, rather than to prolong him, probably only briefly, in hospital, having suffered great physical trauma and most likely in great discomfort. So we are not opposed to the form. We were both surprised however, to be presented with this form, without anybody having mentioned it or discussed it with us previously. At the time, since the nurse referred to the form as having been 'agreed' I assumed they had previously discussed it with Mum, but she was as surprised to see it as i was. i thought she was quiet. Advance directives and DNAR forms provide a means for patients to communicate what sort of medical treatment they would prefer to receive if they reach a stage in their illness where they are lacking the mental capacity to make decisions. When Mum and i both hold power of attorney for Dad it surprised me that the doctor didn't even mention this form when he was here a few days ago. He is their GP and as such has had a relationship with them for several years prior to the past few months. We were both quite shocked to find ourselves, without warning, holding a piece of paper instructing people Not to attempt to resuscitate Dad. However, although advance directives are often completed by ill people, DNAR forms can also be completed by a doctor, independent of any input regarding the patient's wishes, on the basis that in the final stages of incurable illness, CPR is unlikely to be clinically successful. Clearly that is the situation we are in and as i said, we do not contest the decision, as on balance we think it kinder to Dad. We are still a bit shocked though; wouldn't you try to warn the patient's family and discuss it, or at least explain the decision, rather than just hand it over?