Could three words change the way severely ill patients and their loved ones think about death?
Spiritual leaders and some medical staff at hospitals across the USA believe so, and they are reconsidering how they pose one of life’s toughest questions:
Do you want to sign a “Do Not Resuscitate” form?
When they ask, family members often balk. They believe they are giving up, condemning a loved one to death.
….says “do not resuscitate” means doctors will not perform cardiac resuscitation. But they will do everything up to that point.”
Nice theory.
I know of a lady whose family put her into a nursing home, had her drugged pretty much sensless and then disuaded her feeding. She lasted a year, amazing enough. My family tried the legal route to save her but that didn’t work. My discust with the legal and medical system is complete. Never put yourself at their mercy. Pray that you always have someone nearby who actually loves you.
Their definition of “natural death” and God’s idea of the same is quite different, I do believe.
Don
Trips to the Operating Room recind Do Not Resuscitate orders (DNR). One of the things anesthesia providers do is resuscitate. Death in the hospital comes in inches. It can create dilemmas for families. At what point does the love one not expect to recover to a useful and meaningful life? When they brake the hip? After the infection from hip surgery?, After the pneumonia? After the intubation and high dose antibiotic therapy? Our most expensive health care occurs and more dollars are spent at the time just before our death than at any other time in our life generally speaking. Health care refrom will require rationing and dollars spent on false hope at the end of life will not be seen as wise by the health care reformers. But who decides when it is false hope? I don’t know if I want a health care cost wonk in DC deciding my fate so some illegal immigrant can get her breasts reduction done for no charge.
(black humor)[blockquote]After the intubation and high dose antibiotic therapy? Our most expensive health care occurs and more dollars are spent at the time just before our death than at any other time in our life generally speaking.[/blockquote]
Of course, the answer to this is to kill everyone 6 months before they are supposed to die. (/black humor)
A very strong line needs to exist between withholding of care and active measures to end life. I balk at withholding food and drink (even in IV form) because these are not medicines, but are food and drink. But withholding medication, breathing tubes, “heroic measures” and the like are not causing people to die.
Withholding care is simply allowing nature to take its course. Active measures (such as drug overdoses) are murder. The choice of when to withhold care should be made with the patient, the family, the doctor, and the patient’s/family’s clergy person.
Another caution needs to be stated. If death is close in either case, I would NOT withhold treatment. There is going to be guilt enough when a loved one dies – why add to the guilt with the (false) thought that I allowed the death to happen?
YBIC,
Phil Snyder
I have a “Do not resuscitate” living will, and my wife and children are on board with that decision.
[blockquote]‘Do not resuscitate’ vs. ‘allow natural death’ [/blockquote]
Ambiguous headline. Till I began reading this article, I thought Kendall had posted another story about the economy.
4. Evan Miller……same here.
You know, I am a conservative. albeit a reluctant one. I am a RELUCTANT conservative because just when I find myself agreeing with other conservatives, somebody always ends up making a sarcastic, IGNORANT comment like this:
“I don’t know if I want a health care cost wonk in DC deciding my fate so some illegal immigrant can get her breasts reduction done for no charge. ”
There is a certain “spirit” about many conservatives, and it sure isn’t Holy.
Not to sound flippant about a serious subject but after reading the headline I swear my first thought was that the article was referring to banks and automakers. I’ve been watching waaay to much tv.
goldndog, I see a lot of off comments from liberals, too, so it’s best to realize that human failings occur across the spectrum. And even bad days.
Generally speaking, I want my family to make my last decisions if I’m not able to, and not some health-care bureaucrat who is not familiar with my specific case.
Katherine, I agree with you. My wife and I each have a Living Will. It may not be legal in our state but it cetainly gives direction to our children. If I’m determined by Medical Authorities to be absolutely “brain dead” then please pull the tubes and let me go. My wife has the same thought for herself.
I’m fortunate that in my state, Kentucky, such wills are legal and there is even a template offered on-line that meets the necessary requirements.
Goldndog I am sorry if you don’t like my “spirit”. I have spent 30yrs in the health care field. I have read about, heard about and talked to people have been involved in “universal health care” systems. In New Zeland if you are over 75 you do not get dialysis, you get to either pay out of pocket or die. In England care is rationed causing 47% mortality from breast cancer as compared to 27% in the US. Care is often determined by priorty established by policy makers. My comment is not ignorant. We spend millions of dollars treating illegal immigrants and their dependants at tax payers expense. We had one young man (illegal immigrant) who wanted the hospital to pay for his parents to come up from Mexico to look after him!
#8 Me too! LOL.
#5, #8, #13. Me too… Quickly skimming T19 headlines in “mobile mode” this morning, I thought for sure this was an op-ed on the economy based on the headline! I have just now discovered otherwise!
I have had to do the DNR talk. It is frustrating to hear a family say “do everything for Granpa” when his body is riddled with metastatic cancer. So instead of letting him go peacefully, they want him to die a violent death with the physicians and nurses being the perpetrators of the violence. I have only rarely participated in codes where the the ribs weren’t going crunch, crunch, crunch at the end (from all the rib fractures). Rib fractures are VERY painful if you are young and healthy. If granpa is resucitated and live for another few hours or few days with them, is this what he wants? How about electrical shocks? No thank you.
Robroy #15, you are right on. I always tell patients that there is never “nothing we can do.” We can still offer the patient who has signed a DNR considerable support until the moment that s/he dies. And we have to remember that for the believer, physical death is not the end…
Really important topic. And a nice article given it’s source.
Agree with those who value the loved one who knows your wishes.
Take it from me, we can keep a near corpse alive for a few days head down in the ICU on the ventilator. I wouldn’t wish it on anyone.
Also agree there is really never “nothing we can do” the question always becomes “should we be doing it.”
The New Zealand/ dialysis reference (also UK applicable) is on topic for sure for “Obama Medicine” but probably doesn’t really apply to these EOL (“end of life”) issues.
Also just FYI Medicare is spending about a third of it’s resources on the last few months of people’s lives- and not always wisely.
And #1: Nice anecdote, apropos of nothing. Sounds criminal to me if anything- or a family problem. Certainly not the right way to handle things and not really what is being discussed.
I myself wouldn’t claim to know God’s definition of “natural death,” though I’ve seen a lot of prolongation of “manmade torture.”
#2 Dave B, just to clarify, trips to the operating room DON’T necessarily automatically rescind DNR orders. As an anesthesiologist, seeing a DNR order means I need to have a brief chat with the patient and/or their healthcare power-of-attorney about their wishes should grandpa or grandma code in the OR. Most codes in the OR are due to reversible causes (severe hemorrhage, effects of anesthesia on a decompensated patient), and, in most cases, patients (unless they’re in extremis) can be resuscitated. Whether the patient WANTS to be resuscitated should something happen is what a good anesthesia provider and the surgeon should clarify BEFORE going into the OR. In my experience, even terminally-ill patients mostly want to be resuscitated in the OR IF it’s a readily-reversible cause. But, one still needs to have the talk.
And, ditto to both Phil Snyder’s comments on withholding “heroics” vs. active life-terminating actions, and robroy’s experience on “having the DNR talk.” it’s an unfortunate truism that modern medicine is really good at extending death in many instances, but not so good in the comfort and compassion departments. Compassionate end-of-life care doesn’t mean leaving patients with a Hobson’s choice of suffering needlessly, or euthanasia. There’s lots that can be done to provide real comfort care, while allowing “nature to take its course.”
Joshua 24:15 Being an anesthesia provider at a medical center for over 20 yrs and having talked with families I find that the surgical staff can be lax passing off the discussion. Many of my attendings tell the family that DNR orders are recinded. How do you deal with the patient with marginal respiratory function who MAY require an overnight or a day in a unit on a vent but the family doen’t want resuscitation? You well know that many of these cases are not clear cut. The broken hip is a hugh hit for many elderly and they never return to good function. My crystal ball has a horrible time predicting these type patient out comes. I have one elderly friend who survived a deer stand fall suffering a broken neck. He has been at deaths door more times than I care to think about but pulls out. My point is that one size (as I said when I was in the army) fits nobody. The same for health care protocols.
VU82 The cost of end of life, as a I said is the most expensive in terms of cost in our life. DNR and limited care are directly related to this issue. Who decides, the patient, the patient and family, or a mid level manager with a sheet of statistics in front of him.
Rationing will happen. Just who to and for what and for how long decided by whom. Living wills are the way to go and power of attorney to the loved ones that know your wishes.
Dave B., I’m not disputing that some patients that you and I take care of are on death’s door, and have marginal respiratory reserve, etc. But that doesn’t mean that one simply applies a blanket “DNR rescinded” policy when they end up in the OR. As you so well put it, one size fits none. Maybe your attendings and surgeons need to take the extra time ( not that much more, in my 11 years’ experience) to address the issue. Granted, it’s not a “fun” subject, but it’s one of my responsibilities as doc, IMHO. As I said earlier,the majority of patients that I’ve talked with about DNR status in the OR opt for temporarily rescinding that status, and appreciate the talk. Then we do our best as God gives us the ability. Blessings to you!