DNR order - when can it be used w/o sinning

[BJswife]

Is there ever a time when a DNR (do not resuscitate) order can be used without sinning. My father is 90 and does not want to be hooked up to a bunch of machine if something happens. At what point are we allowed to “let him go?” Can we have a DNR order with his directives that states that CPR is to be stoppped when the hospital is arrived at and nothing further be done if CPR and defibrillation have been unsuccessful up to that point. Can we state that no CPR or other measures may be used at all? We don’t want to sin in this area, and the materials I have read from Priests For Life haven’t answered my questions. Can’t we just die when we die and not take any measures?

 

[Newbie2]

Yes, of course you can.

It would be much different if a 33 year old father had a reasonable chance of survival after, say, an automobile accident; he should be given a chance to recover and live a full life.

But a 90 year old man who becomes critically ill need not have life saving measures taken if he so chooses to refuse them (in advance, if he were to become incapable of making such a decision).

And the family would be under no obligation to allow for such intervention.

Now if he had an infection with a reasonable chance of cure with antibiotics, that would be an entirely different matter if he were to refuse such treatment.

Not all situations are as cut-and-dried, however. What’s a “reasonable” chance for recovery, and what is “recovery” are important grey-area questions that arise in such situations.

 

[Trishie]

from the Catechism of the Catholic Church

“2278 : Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impefe it is merely accepted. The decisions should be made by the patient, whose reasonable will and legitimate interests must always be respected.”

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening of their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged."

 

[JimG]

Sure you can use a DNR order without sin. For a 90 year old, strenuous resuscitation attempts could amount to an extraordinary–and thus unnecessary–means. Whereas for a 20 year old, such attempts would not be extraordinary.

But each case is different. Even at 90, if I were in good health, I probably wouldn’t walk around with a permanent DNR order hanging from my neck.

 

[catholicknight]

Is there ever a time when a DNR (do not resuscitate) order can be used without sinning. My father is 90 and does not want to be hooked up to a bunch of machine if something happens. At what point are we allowed to “let him go?” Can we have a DNR order with his directives that states that CPR is to be stoppped when the hospital is arrived at and nothing further be done if CPR and defibrillation have been unsuccessful up to that point. Can we state that no CPR or other measures may be used at all? We don’t want to sin in this area, and the materials I have read from Priests For Life haven’t answered my questions. Can’t we just die when we die and not take any measures?

I manage life support systems for a living. I have a little experience in this area.

Your question has two levels. The first is spiritual. On that I will give you an answer, but ask that you defer to a priest anyway, since as a layman I can only give my opinion. I cannot give you authoritative spiritual advice. IN MY OPINION as a Catholic layman in the medial field, a DNR order can be signed and followed on anyone at any stage in life, regardless of the circumstances, and there is no sin in this. Unlike food, water and basic medicine, heroic measures can be withheld, in any circumstance, if it is either the will of the patient, or the family, and the medical doctor deems it to be appropriate. The reason why, in my opinion, is because cardio-pulmonary resuscitation (CPR) is a form of “heroic measure.” Hence it is unnatural and extreme. Let’s face it, if I did CPR on a perfectly healthy alert person, I would be prosecuted for assault. There is nothing “natural” or “normal” about the process at all. In a 90 year old patient, cracked ribs will be a certain result, along with a possible lacerated liver, and maybe even a collapsed lung. All of this comes from pounding on the chest. Sorry to be so graphic, but this is truly the case. Ask any medical doctor.

The second question had to do with “when” a DNR can be implemented. Again, let me be frank. You can write anything you want down on paper, and that doesn’t mean it’s going to be followed, especially if there are any ambiguities. The trick to making a DNR work is to keep it simple. Setting things up for CPR during the ambulance ride, only to be discontinued at the hospital, is not very practical. Chances are, nobody will want to take responsibility for it, and the doctor is going to end up talking to you personally anyway before he decides to withdraw support. In which case you might as well not have had the DNR written the way you did in the first place, since it didn’t accomplish what you intended it to do.

Here is what I probably will do on my 90th birthday (or sooner). I will sign a DNR for a “med code only with defibrillator.” If that doesn’t work, “no CPR and no intubation.” That would cover all the bases in a perfectly ethical and “Catholic” way. Then if it’s not my time, the drugs and defibrillator should do the trick. If it really is my time to go, I will go peacefully, without any violence or drama.

That’s my 2 cents anyway. Hope it helps.

PS - you can leave out the defibrillator too if you want, as that is also a type of violence and “heroic measure.” Lot’s of patients opt for “med code only” on their DNR forms. This allows for a reasonable attempt to resuscitate without any pain or drama. If it doesn’t work, the patient dies peacefully.

 

[Viki63]

As a nurse who has had to code patients in the past, I totally agree with Catholicknight’s post.
A friend who’s a nurse not too long ago had to attempt resuscitation on an elderly woman in a nursing home. He said he cringed as he felt her ribs cracking, but he had no choice as she had no DNR order.
It is perfectly lawful and not a sin to let nature take its course at the age of 90. Whereas it could be a sin to withhold comfort measures, including antibiotics.
You will probably want to discuss this with your father’s physician. Then be sure, if you need to call paramedics, that they are aware of any existing DNR or similar orders.

 

[BJswife]

Knight, what is “med code only with defibrillator”? I know what the defibrillator is, having trained in it through the Red Cross. And a form has been mentioned - how do I get one? I want to take care of this ASAP as he’s not getting any younger.

 

[catholicknight]

Knight, what is “med code only with defibrillator”? I know what the defibrillator is, having trained in it through the Red Cross. And a form has been mentioned - how do I get one? I want to take care of this ASAP as he’s not getting any younger.

Again, I would recommend you speak to a doctor about all this. Consider what I write here merely as educational. Don’t take it any further than that.

A “med code only” is when a nurse or paramedic is permitted to give what could be life saving drugs, such as vasopressors and anti-arhythmics, but they are not permitted to do CPR. So there is no violence. The patient is injected with medications that are designed to simulate CPR at a chemical level. They only work if the patient stands a good chance of survival. If, however, the patient is too far gone, they won’t work at all. Adding a defibrillator to the order simply allows the nurse or paramedics to administer electrical shocks as well. Shocks only work in fatal heart rhythms. They are useless after the heart has already stopped. Shocking is a little violent, but generally does little to no damage to the patient. If it works, it can get the patient out of a fatal rhythm, to allow for life saving drugs to do their job.

If you’re trying to avoid violent heroic measures, here are the two things you want to stay away from - intubation and CPR.

Intubation involves inserting a breathing tube into the airway (trachea), and is almost always followed by manual ventilation and then mechanical ventilation (i.e. “ventilator” or “respirator”) - in other words “artificial life support.” Once the breathing tube is inserted, a chain of events will follow that almost always leads to artificial life support. It’s almost unstoppable. Nobody can say how long artificial life support will be needed, but it is a heroic measure. If this is not what you want, then the best way to avoid it is to refuse intubation. Specifying that in the DNR order would be essential.

You already know what CPR is. As I mentioned above, this is always violent, and in elderly patients it usually involves breaking ribs. Those ribs cut into organs after they’ve been broken and CPR continues. This is almost unavoidable.

Now as for getting a home defibrillator, you’ll have to contact the Red Cross or the American Heart Association. I don’t know what the process is. However, I can say this. Defibrillators only work when they’re used IMMEDIATELY after the patient goes into a life threatening heart rhythm. If they’re not used IMMEDIATELY, the chances of converting that rhythm are extremely slim, no matter how much you shock them. The key to making a defibrillator work is IMMEDIATE use.

 

[marthagreys]

I’m a nurse who works in a nursing home. I’ve seen enough of this to feel like there is a big difference between prolonging life and prolonging death. Sometimes resuscitation only drags out the dying process - making it last hours or days instead of moments.

 

[Jesus_N_Cherie]

Is there ever a time when a DNR (do not resuscitate) order can be used without sinning. My father is 90 and does not want to be hooked up to a bunch of machine if something happens. At what point are we allowed to “let him go?” Can we have a DNR order with his directives that states that CPR is to be stoppped when the hospital is arrived at and nothing further be done if CPR and defibrillation have been unsuccessful up to that point. Can we state that no CPR or other measures may be used at all? We don’t want to sin in this area, and the materials I have read from Priests For Life haven’t answered my questions. Can’t we just die when we die and not take any measures?

There is NO sin in a do not resuscitate for an old or deathly ill person. We are not obligated to do all that is mechanically possible to prolong the life that God our Creator is ready to take home. The DNR is not accepting euthanasia in any way for the patient. It is not helping death along. It is simply and totally not doing anything mechanical to bring a person’s body back to life once it has passed away. It is just allowing them to die with TRUE dignity. It is saying “yes” to God’s will.

Please do not feel guilty.