Do Not Resuscitate Orders (Dnr)
Medicine is an amazing science. Doctors can keep you “alive” even when you aren’t.
The heart can be kept beating for years, long after the “conscious awareness,” the “personality,” and the person known as “you” has gone.
When does anyone “pull the plug”? And who is qualified to pull it? There are boards of medical personnel who discuss the medical ethics surrounding this question. Few people want a “committee” to settle end-of-life for them.
Doctors are committed to “saving lives” that might not be worth saving. If you’ve seen people on life support for years, whose families no longer visit, whose bodies are artificially kept alive by mechanical means, you will come to realize that there are fates worse than death.
If you are one of those hapless people whose family members are torn apart by disagreements as to “when is the right time to stop valorous measures,” you might want to make your own decisions before that time arrives.
People who are in a vegetative state, with no chance of recovery, are sad victims of fate. If they did not prepare for this possibility with an advanced health care directive called a “living will,” which is their stated will while they are alive, but unable to speak for themselves, they could be at the mercy of others.
A living will specifies what a person wants when he can no longer make decisions for himself. He must specify a family member or a very-good friend (as the patient advocate or health care proxy) to fulfill his final wishes for him.
That right document (“living will”) should include a “Do Not Resuscitate Order” if you do not want to be “resuscitated” – which usually means using CPR if the heart or breathing stops – if it is very likely that you will be in a vegetative state or resuscitation efforts will most likely be futile. You cannot speak, eat, drink, go to the bathroom, etc. for yourself. All personal needs will be taken over by machines. You may be tube fed to prevent starvation; you may live on IV’s with medication to beget a heartbeat and brain waves.
My husband and I dash motorcycle together. We know our chances of a serious or deadly accident are higher than normal. We created living wills with DNR orders. Neither of us wants anyone to take extraordinary measures to resuscitate us if no possibility of quality of life would be in the odds of recovery.
A friend of ours, also a motorcyclist, created a living will and made his wife the proxy. However, “John” has only one form on file with his attorney, and he gave a second copy to his wife. It costs about $350 to $400 to create a personal will, along with a living will and DNR order. The whole point of a DNR order is to have your final wishes followed in the event that you cannot protest for yourself.
I asked John about his logic. He said he wanted his wife to be the one who ultimately decides whether he should live or die. If she doesn’t “produce” the document for the hospital, they will be forced to keep him alive until she tells them to quit. Then she can produce the document.
I was astonished at this hooked logic. This is a college-educated man, who is usually quite rational. He “paid” for a legal service he really doesn’t seem to want.
A major point of a DNR order is to produce that final decision for yourself and “protect” your loved ones – especially multiple family members with different belief systems – from having to make that decision.
My mother has experienced atrial fibrillation (irregular heart rhythms) seven times and has been in the hospital for it every time it occurs. A few times, she was taken to the ER by ambulance. (A couple times, it occurred while she was in the hospital.) The seventh time, the ER physician asked her if she had a DNR order on file. She asked if she should be concerned. He said, “There are no guarantees; we can’t always bring you back into rhythm. Do you want us to resuscitate you if your heart stops? ” She said, “No.”
My mother returned home again. In preparation for the eighth time, she had an ID tag made up which she wears on a long chain around her neck. It is her personal “DNR” order, which she puts over her head every time she leaves the house.
Medical personnel will try to “bring you help” no matter what. When my 84-year-old father went into the ER with a broken leg and hipbone after a topple, they asked if he had a “living will and DNR order.” He said, “Of course I have a will.”
The nurse explained, before they took him to surgery, they wanted to know if he wished to be resuscitated if his heart or breathing stopped during surgery. He called my mother to discuss it and they agreed, “No.” We talked. I had durable power of attorney and he made it clear, since my mother wasn’t there, I was to give the final order to not resuscitate if he needed CPR.
This was emotional and not a time for quick decisions. He came out of the surgery. I talked to the nurse and said that is a hard decision to make for another person. She said, “Oh, they would bring him out of the surgery room alive; it would only matter if a second incident occurred, and then the DNR order would go into effect.”
To me, this meant, no matter how poorly the surgery went or how unwell or disabled my father would be in the future, he would come out of surgery with a heartbeat.
My dad went into physical therapy for a couple weeks, and then he came home again. But he developed a deadly pneumonia, and was wait on in the ER within three weeks. They took the gurney past me and Dad said “Hi, honey” before they took him behind a curtain 15 feet away while I signed the check-in papers.
A lady doctor tapped my shoulder and asked if I wanted my father put into an induced coma. I said, I think you have the wrong person. She said, “No, I don’t.” I said, “And how would you bring him out of it? She said, “That’s the tricky part.” I said, “Then don’t do it. We talked about this, and he does not want amazing measures taken.”
Dad lived for 17 days. He suffered greatly. His organs were shutting down one by one. He got weaker. He asked me not to ask him to “cease” any longer. I said I wouldn’t. It was time for palliative measures. Mother saw him once more. They put him on morphine through IV’s, which he and I requested. He opened his eyes to look at me a final time. I told him to go towards the light with his brother and nephew. He died within a few hours.
This was years ago. When you are in the winter of your life, you have to make some realistic decisions. The doctor called me at 3:16 a.m. to affirm me Dad had passed. I thanked him profusely for making Dad’s passing easier and quicker. He quickly got defensive and said, Oh, no, we didn’t do anything; that would be illegal. I said I was very grateful to the staff for following our decision. He said, if more people believed as we did, their jobs would be so much easier.
Take this for what it’s worth, but we all, in the end, face death alone and have few choices left to us.
Some people worry that doctors might “kill them off” as organ donors so they can withhold someone else alive. Don’t worry. The bigger fear is over our final care for the elderly (or terminally ill or loved ones in vegetative states) who want to die in peace and with dignity; it seems like the hospital won’t allow it.
In speaking with two different attorneys, when we (my mother; my husband and I) made our living wills, they both said, “If you don’t want to be resuscitated, don’t call the ambulance in the first space.”
It seems, in our litigious society, if the medical personnel detect any hint that there is a division in the family and someone will press for “heroic measures” to be taken, they will use extraordinary means even against the unconscious patient’s wishes.
To make sure your final orders are listened to, your family doctor, the person you’ve assigned as your patient advocate, and your preferred hospital must have copies of your living will and DNR. If you’ve created a living will with an advance directive with an attorney, he will have a copy and tell you who else needs them.
Once you are in a serious accident, unconscious, and barely alive, that is not the time to be searching for documents.
Our family doctor told us, no matter if we have a fatal accident across the country, he will be notified, and he will tell them we have a DNR order on file that is to be followed.
Final note: while we were in our attorney’s office, he received a call about a dying client who they wanted to resuscitate. He told them not to. Someone must have argued with him. He said, “If you resuscitate him, I’ll sue you. I have his DNR order on file. Don’t do it.”
Understand your rights. Talk to your doctor about your final wishes. He has “advance directives” on file with a DNR order attached. Ticket one to keep control over your final wishes. Obtain a copy for your hospital. (All three of us have DNR’s on file.) And find out if you need to involve an attorney in your state to make sure that things are handled “your way.”
Source of some terminology: Www.Wikipedia.org. “Do Not Resuscitate. Usage by Country. United States.” Retrieved on 12-15-09.
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Filed under Medical Alert Necklace by on Nov 17th, 2011. 