Advance directive? i just received a c

  • Thread starter Thread starter anna
  • Start date Start date
Status
Not open for further replies.
Yes, I think it is a good thing to accept death. If one keeps on living, just think how they would feel if everyone they know died naturally and they still go on and on…like the movie, “The Green Mile.” To watch all your friends and relatives die and not to be able to die would be hard. Living until you are 122 or so. Being unable do anything or go anywhere, or drive a car. Who needs it? I would get pretty fed up pretty fast, and forget about deep freezing the body in a cryogenic place to hope to thaw the person out in years to come. I am not really thinking what the church expects or wants. I am speaking from common sense. I am glad I have a DNR and have had one for years. As you get older and sicker, death looks pretty good. I haven’t used my DNR yet because I’m in pretty good shape and probably will be around for a while, long enough to exhaust my resources and my daughter. (I hope not, but she probably would feel obligated to help me.)

Who would take care of such an old person? What if they outlived their kids? And forget Social Security and Medicare/Medicaid. I always pray that God will take me before any of this happens. He isn’t angry with me for asking. It’s not a sin to ask Him to help you out of a bad situation. Nobody enjoys talking about death because it is a taboo subject in many cultures. Death can be a friend in some circumstances. So, if I become a “living dead person” and end up with a DNR, I will let you know. I’ll send a letter from wherever I am, and hope for the best.

My brother died young with cancer of the esophagus and throat. He suffered for two years with chemo and radium. It did not help. He died exactly two years after he was diagnosed. Cancer is a lousy disease, horrible, mean, and I wouldn’t wish it on my worst enemy.

There are worst things than dying. Living this way is worse. I will do what I can to allow this to happen if God wills it but I will definitely pray that He will change His mind and let me come home.
 
edward_george1 said:
DNRs are indicated sometimes for certain diseases or for people of advanced age, wherein to resuscitate them would be extremely traumatic (@Pup7 can probably fill in more on the specific medical practice here), and likely result in the person suffering major injuries that result in severe pain and a strongly diminished quality of life for the remainder of their time. A person should not simply have a DNR just to have one, but with careful consultation with their doctors and next of kin, they may determine that it would do more harm than good to resuscitate them, and so if cardiac arrest came, it would be best to let nature run its course.
Click to expand...
Thanks for the call. 🙂

Actually any patient can sign a DNR at any time for any reason. Legally the only limits are the patient’s own conscience.

I’m only going into detail here because I’m reading a lot of misconceptions about what these documents are and can and cannot do.

Since the Terri Schiavo case, every hospital in the United States is required to ask every patient at every admission if they have an AD, a Medical Power of Attorney, and/or a DNR. If they wish to execute any of these documents, as far as I know the facility must provide the means by which to do it. (They’re usually prefab forms, and for many people are better than nothing and also start conversations they may not have had before that moment.)

There’s a difference in an advance directive and a DNR.

An Advance Directive is a legal document stating how far the patient wants care to go - in other words, do they want feeding tubes, mechanical ventilation, or other forms of extraordinary care. They can be as specific or as general as a patient likes.

A DNR is a Do Not Resuscitate order - in other words, if the patient experiences cardiac arrest, the medical team is not allowed to begin CPR or take other measures to “bring the patient back”. An AD may request a DNR, but you can have a DNR without an AD.

Most hospitals have very simplistic AD’s on hand that can be witnessed and made legal at the point of admission, or a patient can bring a copy of their own AD for inclusion into the medical record.

Continued…
 
Last edited:
The problem with an AD is it can be overridden. All the AD does is absolve the medical team of liability if they follow it. But a family member can override the AD, as can a physician.

A family member who holds Medical Power of Attorney can also legally step in and tell a team to stop CPR (we call that “calling the code”) if it’s been started and the family wishes it to stop before the team calls the code (pronounces death). If there is no medical POA, a lot of times the team will begin talking to and asking the next of kin if they want to proceed - also legal.

A DNR can’t be overridden by the care team. If a DNR is not in place we can begin CPR. A DNR is only binding in the hospital and must be rewritten at every admission. There are out of hospital DNRs, though.

From the American Bar Association:

https://www.americanbar.org/content/dam/aba/migrated/Commissions/myths_fact_hc_ad.authcheckdam.pdf

Keep in mind I’m speaking broadly. Laws for these documents vary from state to state, though having lived in several states (when it comes to these documents, all military treatment facilities are required to honor the state laws of the state the facility is in) DNRs seem to have few differences.


I hope this is helpful.
 
Shakuhachi said:
Too ften a DNR is seen as “doing nothing” but actually the goals of care have shifted.
Click to expand...
A DNR is indeed doing nothing if the patient experiences cardiac arrest.

A DNR is not comfort care. It’s an order to not resuscitate the patient in the event their heart stops. It is separate from the care plan for the patient and only kicks in if CPR were to become necessary. You can be in hospice and have a DNR, or you can be going in for routine treatment and have a DNR.

You can also be in hospice and not have a DNR.
 
Last edited:
Agreed, what I am trying to process is do they, meaning doctors, nurses and family put the directive in place for every situation, God bless
 
Thank you.

I will state firmly and unequivocally–one of the greatest gifts you can give your family is an advanced medical directive.

If your loved one–a parent, for example–is in an ‘end of life’ condition, and the medical team does not have an advanced directive in hand, they will ask YOU what to do.
You do not want to be in that position. From personal experience, I tell you this.

One year ago Monday, my mother was unconscious in a trauma care unit after having suffered a stroke. Her chances of survival were nil.

I’ll spare the personal details. The doctors asked us, “What do you want us to do?”

She had, several years previous, arranged an advanced directive. Unfortunately at that time, the trauma team had not yet had the AD in their physical possession.

There is no decision more difficult to make than to try to figure out what she would have wanted. BUT–the doctors also told us this: Without having that AD in their possession, and without a clear answer from us, they would do everything possible to keep her alive. The default decision is to save the life.

Luckily, within hours the doctors were able to obtain her AD. But in the meantime—you don’t ever want your loved ones to be in that position.
 
Last edited:
Yes and Comfort Care can be an alternative plan of care that is not " doing nothing". So we don’t have to see DNR as giving up on a patient. We could change the focus from “do everything to keep me a live” to “keep me comfortable” and that would include forgoing chest compressions and epinephrine if my heart stopped. But the plan, rather than doing nothing, you can hold my hand, wipe my face with a wash cloth, if I am in pain give me something for that, etc.
 
People can change their mind about a DNR revoke it later.

Also, DNR doesn’t mean "no medical treatment whatsoever ".

One of our DNR residents fell and broke her hip. After consulting with her and her family (she had mild cognitive decline), we sent her to the hospital for X-rays and she wound up getting a brace and some pain medicine and they sent her back.
This was last year. She’s still alive and receiving visitors and doing pretty well all things considered.
 
anna said:
Agreed, what I am trying to process is do they, meaning doctors, nurses and family put the directive in place for every situation, God bless
Click to expand...
No, in these facilities, they do ask everyone what their code status is. Your friend was alert and oriented, which means that these decisions would be made by her solely. Even if she has a designated family member who is her medical POA, that only comes into play if she loses the ability to make decisions for herself. I, for example, am the designated POA for my parents. However, I am completely powerless to go to their doctor and demand that he makes them a DNR behind their back, and to keep this designation hidden from them. Because they are alert and oriented people, they are fully capable of making their own medical decisions. I would rightly be told to go take a long walk off of a short pier.

Same concept even for those in nursing homes. Designated POA, even for nursing home residents, only have their power when the patient loses the ability to make decisions for themselves. A family member can not secretly go into a nursing home and secretly make a person a DNR, and then a nefarious doctor can not secretly just say ok, and then jeep this knowledge from their patient. That is not how it works.
 
I thank you for that, I am going to compile all the information and start with the Church,s ruling on this. My friend, and her name was Joyce had so much joy and love in her for her children…Again [ there being a DNR they would not have had to deny that., when she fell she called out for help this is what I question , her heart did not stop until she was gone…
 
Last edited:
Pup, I agree with all you said, but a DNR is not just for a hospital, you can also have one in a long term care facility, and hospice care.
 
This is why the National CAtholic Bioethics Center has a great publication to explain things.

Many people choose to appoint a person with a durable medical power of attorney. This would be someone who knows the teachings of the Church wrt end of life issues and whom you trust to respect your wishes.

I have chosen my sister’s husband. He loves me, I love him however he is a very calm man who knows how to make rational decisions in times of great stress. While not Catholic, he well knows the teaching and where to seek answers. It takes the burden off my spouse, adult kids, at a time when they will be very emotional.

That works for me.

On the other hand, my husband wants every medical intervention available. We all respect his wishes that way.

https://www.ncbcenter.org/publications/end-life-guide/
 
As your husband, would he be able to intervene if he does not agree with your brother-in-law,?? Legally I mean
 
In our state, yes, however my husband is very ill. The chances he will outlive me are slim to none. And even in the case DH does outlive me, we made this decision because my husband is not comfortable making the decisions in that case. He welcomes the idea of a strong, clear head if that time comes.

Every one of my friends and family members knows well my desires. We talk about these things. I am surrounded by death (I work for a large parish), death, dying, funerals are a regular part of our lives. It is not a taboo, whispered topic.
 
Last edited:
Presumably the person with power of attorney over them. This, again, stresses the importance of having your legal house in order- Life is unexpected, and death can strike at any time.
 
Last edited:
I would appreciate your opinion on something, Drug addiction is called a disease of the brain…It is a primary disease that slowly affects other organs which start to break down. If someone overdoses on an opioid they are in great danger of loosing their lives, which is becoming more and more common. Their breathing becomes shallow or they stop breathing altogether, they can be brain damaged quickly and die just as fast. They have a drug called narcan which the police now carry and when one calls 911 if administered within minutes reverses the effects of the opioid . Most states have the 'Good Samaratan Law in place , protects the caller and others from arrest and the police ,in all probability take them to a hospital- I know addiction must be awful…my point is no DNR, no Da. one needle brings them back, I’m sure some were worse then those on DNR.yet some don’t have that choice, the gift of life is given back to them…God bless.
 
anna said:
Agreed, what I am trying to process is do they, meaning doctors, nurses and family put the directive in place for every situation, God bless
Click to expand...
No. Medical personnel cannot make someone have any sort of advance directive. We don’t put anything into place - the patient does. Or the patient’s power of attorney holder if the patient cannot speak for him or herself.
 
anna said:
my point is no DNR,
Click to expand...
That’s not what a DNR is.

A DNR is a Do Not Resuscitate Order. Not an order to not treat an overdose.

One needle will not bring you back if you’re in cardiac arrest.
 
Status
Not open for further replies.
Back
Top