Sunday, November 12, 2006

DNR (Do Not Resuscitate)

Our dad forwarded to all six of his children the following "Living Will." He said that, while he recognized its intended humorous side, he is considering taking to his attorney "and perhaps similarly changing my instructions":


I, MAXINE, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead politicians who couldn't pass ninth-grade biology if their lives depended on it, nor lawyers/doctors interested in simply running up the bills.

If a reasonable amount of time passes and I fail to ask for at least one of the following:

Glass of wine
Cold Beer
Chicken fried
creamy gravy
Mexican food
French fries
ice cream

It should be presumed that I won't ever get better.

When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and call it a day.

My next younger brother, who, about 10 years ago, was struck by a car and declared dead on the scene, but later revived, wrote the following:

-----Original Message-----
From: Pete
Sent: Sunday, November 12, 2006 5:39 AM
To: Dad, Holzmann-sibs
Subject: Re: DNR's (was: Maxine's New Living Will)

Actually this has a serious element, Dad.

We recently discovered, to our horror, that many MANY doctors have taken a very different view of "DNR" (Do Not Resuscitate) orders than we ever imagined.

What we always thought (and a very common perspective among friends):

* If you want reasonable steps to be taken in case of
    serious illness...

* But don't want "them" keeping your body going forever
    if something really bad happens...

* Then that's when you want a "DNR" order.

Today's reality:

* If a doctor has a "DNR" order on file for a patient...

* And the patient is very ill...

* Then many many doctors *explicitly* will say "don't
    treat that patient -- they want to die anyway"...

* Or, they may use "slow code" treatment, hospital-speak
    for acting slowly and deceptively in a way known to lead
    to death. [Case study: injecting life-sustaining meds
    into the mattress instead of the patient!]

* AND because the "DNR" order is legally binding and
    is in the hands of the doctor, loved ones who want to
    insist on proper care for the patient will have a REAL
    fight on their hands, to get the DNR order rescinded!

That's right: instead of

    "don't RESUSCITATE if they're gonna be a vegetable"

it's now

    "don't TREAT because they want to die anyway"


    "don't TREAT because they won't have a 'happy' life anyway."

(They're just "helping you along" a bit... with your "desired" lack of treatment you will soon succumb, and then not be resuscitated, and then be blissfully moving on and no longer taking up space on the planet... YECCCH!!!)

Literally, the professional argument is now over "quality of life" and "probability of recovery"... and many doctors simply decide that since the statistics say you will not enjoy life, your DNR says you prefer to die. This is vanishingly close to eugenics.

In light of this:

1) We're finding several (good!) facilities that explicitly say
    "if you come here for treatment, we will ignore any DNR
    order. After all, you are here to be treated, not to die."

2) We have torn up our DNR orders and instead have created proper
    (current) Medical Power Of Attorney documents.

3) Bottom line: ensure you have a loved one who understands,
    who will fight for your life as needed, and who will make the
    tough decisions... NOT a doctor you don't know!



PS: You might find these resources illuminating:
[Case studies with disabled children (!)]
['Slow code' deceptive non-treatment of patients, and serious discussion of why it happens]
[The AMA outlines a reasonable negotiation process, based on NOT having a DNR order]
[Overview of some topics. One that concerns me: there's a software package called "APACHE" that is increasingly used to make decisions on treat-or-not. Will we soon be told "sorry, the software says Pete won't make it, so we won't be taking him to the hospital"?!!]

As a one-in-a-million case of "non-CPR spontaneous recovery", this topic carries some import for me personally. ;)
blog comments powered by Disqus