Do not Resuscitate orders

[THutch04]

I’m just starting to learn about this topic in my health care ethics class, and I’m curious about this issue. Everyone has been saying it’s acceptable for a TERMINAL or elderly patient to have a DNR order, but what about someone who is young and basically healthy, and honestly believes that if something should happen to them that it’s just their time to die and they don’t want someone to try to resuscitate them?

 

[paramedicgirl]

I’m just starting to learn about this topic in my health care ethics class, and I’m curious about this issue. Everyone has been saying it’s acceptable for a TERMINAL or elderly patient to have a DNR order, but what about someone who is young and basically healthy, and honestly believes that if something should happen to them that it’s just their time to die and they don’t want someone to try to resuscitate them?

In British Columbia, DNR orders must be signed by both doctor & patient and are valid for 1 year. Families are told (and it is written on the form) not to call 911, because once we start resuscitation, we have to continue for 30 minutes or until the patient is either resuscitated or in the ER. We carry copies of these forms in each ambulance, and when we are dispatched to a cardiac arrest, we check our DNR’s.

A doctor in BC will NOT let a healthy person sign a DNR. It says right on the form it is only for terminally ill or end of life patients.You can check if it’s different where you live.

 

[Pug]

It is interesting, this talk of a healthy person signing a DNR. I do know healthy people who would not want to be resuscitated if something had just happened to them so that even if they were successfully resuscitated, they would have a smallish chance of returning to any kind of a “normal” life. I don’t know what would do that, medically. Maybe being part-drowned?

Just so you know, these people I know are not Catholic.

 

[paramedicgirl]

It is interesting, this talk of a healthy person signing a DNR. I do know healthy people who would not want to be resuscitated if something had just happened to them so that even if they were successfully resuscitated, they would have a smallish chance of returning to any kind of a “normal” life. I don’t know what would do that, medically. Maybe being part-drowned?

Just so you know, these people I know are not Catholic.

Isn’t that the same as a living will? Which the church condemns?

 

[Pug]

Isn’t that the same as a living will? Which the church condemns?

I think it does have some of the same intent. And yes, what the people I had in mind wish to do is condemned by the Church. That these people exist unnerves some people, that’s why I mentioned them. I wonder if they are part of the subtext beneath this DNR discussion. I know I am scared by the stories in the Netherlands about how doctors will euthanize people. If it can happen there, it can happen here. If they can stop feeding you here (Terry), who knows what they’ll think of next? Doctors routinely seem to give amneo to test for down’s in older mothers, and down’s people can get aborted. I don’t trust what doctors think about very disabled people.

I guess as a child I trusted doctors so much, so once I hear about stuff like that, it sort of shakes a person up. It breaks a childhood trust. Maybe that is why the DNR discussion is the way it is here?

 

[paramedicgirl]

I think it does have some of the same intent. And yes, what the people I had in mind wish to do is condemned by the Church. That these people exist unnerves some people, that’s why I mentioned them. I wonder if they are part of the subtext beneath this DNR discussion. I know I am scared by the stories in the Netherlands about how doctors will euthanize people. If it can happen there, it can happen here. If they can stop feeding you here (Terry), who knows what they’ll think of next? Doctors routinely seem to give amneo to test for down’s in older mothers, and down’s people can get aborted. I don’t trust what doctors think about very disabled people.

I guess as a child I trusted doctors so much, so once I hear about stuff like that, it sort of shakes a person up. It breaks a childhood trust. Maybe that is why the DNR discussion is the way it is here?

I think there is some merit to what you are getting at. If I understand you correctly, you are saying that DNR orders can be the catalyst for opening the door to euthanasia. Even though DNR’s of themselves are not immoral or intrinsically evil, you are saying that society will use them as a stepping stone to euthanasia where euthanasia is still not legal. Is that a fair assessment of what you mean?

 

[BLB_Oregon]

The chances are, unless you laminate your DNR and hang it around your neck, that if you were to collapse in the street the paramedics and the staff in the emergency department would try to resuscitate you. They don’t have time to let you die while they look up your paperwork. In this day and age, hospitals don’t spare any effort in resuscitation without directives from the patient or family…and the tie goes toward resuscitation. They don’t want to be sued, if nothing else.

What is very, very important is to investigate what kinds of interventions hospitals do–your primary care physician can help you with this–and explain to your doctor (if they don’t already know the Church position) and your family the ethics of each and what you want done if it is you. Then put it in writing and have your doctor put it in your chart. If nothing else, remember that your pastor takes that pager or cell phone with him everywhere for just these kinds of questions, and not just for people who need “last rites.” If you can’t talk about this kind of stuff with your family, talk to your pastor about what you want and ask if he will be willing to explain things to your family when the time comes. Then make sure your family has your pastor’s emegency number!

Oh, and don’t forget to remind your family of that, either: Annointing of the sick is not a death sentence. It is appropriate for anyone who is seriously ill. Let them know that if you are seriously ill, you want them to arrange for Annointing of the Sick for you immediately…and that you will not take that as a sign that you should should have told somebody who gets your china.

A lot of people carry a card that says they want annointing of the sick, but if your family brings you in, the staff won’t be going through your wallet looking for it. Let your family know.

 

[paramedicgirl]

The chances are, unless you laminate your DNR and hang it around your neck, that if you were to collapse in the street the paramedics and the staff in the emergency department would try to resuscitate you. They don’t have time to let you die while they look up your paperwork. In this day and age, hospitals don’t spare any effort in resuscitation without directives from the patient or family…and the tie goes toward resuscitation. They don’t want to be sued, if nothing else.

What is very, very important is to investigate what kinds of interventions hospitals do–your primary care physician can help you with this–and explain to your doctor (if they don’t already know the Church position) and your family the ethics of each and what you want done if it is you. Then put it in writing and have your doctor put it in your chart. If nothing else, remember that your pastor takes that pager or cell phone with him everywhere for just these kinds of questions, and not just for people who need “last rites.” If you can’t talk about this kind of stuff with your family, talk to your pastor about what you want and ask if he will be willing to explain things to your family when the time comes. Then make sure your family has your pastor’s emegency number!

Oh, and don’t forget to remind your family of that, either: Annointing of the sick is not a death sentence. It is appropriate for anyone who is seriously ill. Let them know that if you are seriously ill, you want them to arrange for Annointing of the Sick for you immediately…and that you will not take that as a sign that you should should have told somebody who gets your china.

A lot of people carry a card that says they want annointing of the sick, but if your family brings you in, the staff won’t be going through your wallet looking for it. Let your family know.

You make some good points here. If a patient is not actually wearing a DNR bracelet, and they collapse outside the home, and we are not able to immediately identify them, yes they will receive full resuscitative measures. Its happened before, and will happen again.

Another good point you made is to make your family aware that you want the priest called if you are ever brought in to the ER. We only look through wallets for ID if there is no other way to identify a patient, so if family members bring you in, it’s up to them to tell the nurses to call a priest.

I carry a Catholic card right on top of my driver’s license, so it would not be missed by anyone fishing through my wallet for ID in the event of an accident. I have also made it clear to my family and fellow paramedics that if they ever bring me in to the ER, I want the priest called as a top priority.

And my family already knows who gets my china!

 

[AndyF]

I have a question about DNR orders and how, if at all, they fit in with Catholic theology. My grandmother is in the last stages of Alzheimer’s disease and has hospice care that comes to my mother’s home to care for her. The hospice has asked my mother about DNR orders and then my mother asked me. I really don’t know what to recommend. On the one hand, I know when God is ready for her, then she will pass away no matter what is done to try to keep her alive and on the other hand she is sufferring so much and I don’t know how painful the rescue efforts could be to her. I need help in how to direct my mother.

We can’t be presumptuous of the roll of God in individual cases. What He wants and what we know for sure is that we are to save lives at all times. He takes over from then. Suffering is a part of life, and serves sometimes to lessen our Purgatory stay and debt to be paid because of our sins.

Miracles can still occur, and perhaps He would have one planned after we do our part. Disregarding His law may short circuit His plan, but even if this is not the case, the patient is headed for a far greater reward.

Andy

 

[Coop73]

We can’t be presumptuous of the roll of God in individual cases. What He wants and what we know for sure is that we are to save lives at all times. He takes over from then. Suffering is a part of life, and serves sometimes to lessen our Purgatory stay and debt to be paid because of our sins.

Miracles can still occur, and perhaps He would have one planned after we do our part. Disregarding His law may short circuit His plan, but even if this is not the case, the patient is headed for a far greater reward.

Andy

**I believe this as you say and understand it. I am new to the Catholic Church and am struggling to understand and advise in a way that is in line with Catholic teaching. So, is what you are saying is that a DNR would go against the Church? **

 

[paramedicgirl]

**I believe this as you say and understand it. I am new to the Catholic Church and am struggling to understand and advise in a way that is in line with Catholic teaching. So, is what you are saying is that a DNR would go against the Church? **

Living wills and euthanasia go against the church’s teachings. DNR’s do not.

 

[mosher]

Living wills and euthanasia go against the church’s teachings. DNR’s do not.

A living will is in no way intrinsically contradictory to the faith. However, certain things that can be contained therein can be contrary to the faith. If a living will is established then all instructions contained must conform to catholic social teaching and catholic bioethics.

On the issue of DNR’s: There is nothing intrinsically wrong with them. However a warning. With a DNR it gives the doctor the right to determine when to not necessitate which really means that it gives the hospital lawyers the right to determine the interpretation of the document. This is always interpreted in the most narrow way in order to spare a hospital liability. So, this has the effect of them not erring on the side of life but rather siding on the side of death even if they can resuscitate and save the persons life through ordinary means.

An example: Mary has a heart attack. Mary is taken to the hospital and flat-lines while the doctor is working on her. Mary has a DNR. The doctor after the flat-line does nothing to resuscitate Mary because of the DNR. However, it was possible to use the paddles or some other method to resuscitate the person. This is not an ethical practice but common with DNRs.

Solution: The solution is that a person is given medical power of attorney. With this authority the instructions are given by a person and are then to up to the interpretation of the hospital staff. This person chose should understand catholic teaching on life issues. This protects the hospital from liability and the person from being allowed to die in an unethical way but also allows for the person to die in an ethical and dignified way if that is the situation.

Documents giving instructions about unforeseen events and circumstances are always dangerous.

 

[Coop73]

Okay, but if I advise my mother that a DNR is okay then am I choosing death instead of life, keeping in mind that I am speaking of my grandmother who suffers from alzheimer’s disease and congestive heart failure. Would it be better to err on the side of life and advise to try all life saving measures? I am not trying to have someone to make the decision for me, just want the decision and advise to be correct.

A living will is in no way intrinsically contradictory to the faith. However, certain things that can be contained therein can be contrary to the faith. If a living will is established then all instructions contained must conform to catholic social teaching and catholic bioethics.

On the issue of DNR’s: There is nothing intrinsically wrong with them. However a warning. With a DNR it gives the doctor the right to determine when to not necessitate which really means that it gives the hospital lawyers the right to determine the interpretation of the document. This is always interpreted in the most narrow way in order to spare a hospital liability. So, this has the effect of them not erring on the side of life but rather siding on the side of death even if they can resuscitate and save the persons life through ordinary means.

An example: Mary has a heart attack. Mary is taken to the hospital and flat-lines while the doctor is working on her. Mary has a DNR. The doctor after the flat-line does nothing to resuscitate Mary because of the DNR. However, it was possible to use the paddles or some other method to resuscitate the person. This is not an ethical practice but common with DNRs.

Solution: The solution is that a person is given medical power of attorney. With this authority the instructions are given by a person and are then to up to the interpretation of the hospital staff. This person chose should understand catholic teaching on life issues. This protects the hospital from liability and the person from being allowed to die in an unethical way but also allows for the person to die in an ethical and dignified way if that is the situation.

Documents giving instructions about unforeseen events and circumstances are always dangerous.

 

[Pug]

I think there is some merit to what you are getting at. If I understand you correctly, you are saying that DNR orders can be the catalyst for opening the door to euthanasia. Even though DNR’s of themselves are not immoral or intrinsically evil, you are saying that society will use them as a stepping stone to euthanasia where euthanasia is still not legal. Is that a fair assessment of what you mean?

I’ve got several things just banging around in my head, so I’m being confusing. I think you have picked up on the drift of one of them. I’m definitely worried. I think many things have brought end of life issues up front in people’s eyes, especially how to let life go on or to stop trying or whatnot. I’m worried people are more and more going to go with stopping trying or worse.

I also think a DNR is just fine, as you said.

 

[oldfogey]

An example: Mary has a heart attack. Mary is taken to the hospital and flat-lines while the doctor is working on her. Mary has a DNR. The doctor after the flat-line does nothing to resuscitate Mary because of the DNR. However, it was possible to use the paddles or some other method to resuscitate the person. This is not an ethical practice but common with DNRs.

This is incorrect. Defibrillation is resuscitation, and it would be a breach of ethics if the doctor proceeded with “the paddles” when they know a DNR is in effect. The ethical practice is to follow the DNR.

 

[oldfogey]

Okay, but if I advise my mother that a DNR is okay then am I choosing death instead of life, keeping in mind that I am speaking of my grandmother who suffers from alzheimer’s disease and congestive heart failure. Would it be better to err on the side of life and advise to try all life saving measures? I am not trying to have someone to make the decision for me, just want the decision and advise to be correct.

Dear Coop73,

Medical studies have been done on the effectiveness of resuscitation. One very large study looked at a couple thousand cases. It found that for people over 69 with one or more chronic medical problems, the chance of surviving a cardiac arrest and be discharged from the hospital was only a few percent, and most of those were discharged to a nursing home, often with respiratory support. This highlights that for the elderly with multiple medical problems, resuscitation can be considered an extraordinary means as it has little chance of success.

 

[Karin]

NEVER sign a DNR order. It is an excuse for medical personnel to deny a patient any and all medical treatment.

Not true…please dont go scaring people with mis-information!

 

[cathlicnlovinit]

My mother died from lung cancer about 7 years ago. The first thing they asked us was if she wanted a DNR. We said no. She stayed in the hospital for about 2 weeks. As she was there the tumor grew and began to block her air way. They had to intubate her. The doctors again toward the end asked me if we were willing to issue a DNR. In this case it meant that they would not do CPR or re-intubate her because of the blockage to her airway. One lung was totally blocked the other was partially blocked so intubation would have been painful and essentially pointless. So she received a face mask with the highest level of pure oxygen possible to receive until she breathed her last breath. God… this is still hard to talk about after 7 years. I was her medical power of attorney. he had no one else. She and my dad were not married. It was just so terrible because of my age. The doctors did not feel that I was old enough to make the decisions so I had to have my dad or aunt there to back me up and make the doctors stop trying to ask my sick, dying mom questions when she was unable and ask me (I was only 21 when she died, I turned 22 the next day.) So while I don’t think that DNR’s are bad in and of themselves, I think the circumstances have to be considered. As I said, in my case it also ment no re-intubation. Although she stayed on feeding tubes and fluids.

Heather

 

[paramedicgirl]

Originally Posted by mosher

An example: Mary has a heart attack. Mary is taken to the hospital and flat-lines while the doctor is working on her. Mary has a DNR. The doctor after the flat-line does nothing to resuscitate Mary because of the DNR. However, it was possible to use the paddles or some other method to resuscitate the person. This is not an ethical practice but common with DNRs

.

This is incorrect. Defibrillation is resuscitation, and it would be a breach of ethics if the doctor proceeded with “the paddles” when they know a DNR is in effect. The ethical practice is to follow the DNR.

I would have to disagree with mosher and agree with oldfogey. DNR, as I have stated repeatedly, means no CPR. No CPR means no defibrilation, since we prime the heart with CPR prior to defibrillation. So, in effect, DNR means that we will not restart your heart once it quits. Defibrilation in mosher’s scenario would mean restarting a heart that was probably in asystole. That would be resuscitation.

 

[ElizabethPH]

OK this has really got me going. If you read the Catechism it tells you.

Now you all having me believe I did the wrong thing. This is really hard for me to say this and as I do it tears me apart. I spent 3 months in the hospital watching my husband die. I signed the DNR well after he got sick and he had already been through so much. When he had the aneurysm it killed him, he passed right in front of my eyes in the ER; they brought him back. He lost his colon…he had to have several surgeries…he went into renal failure; he had several dialyisis treatments. He could not breath without a vent it was in for so long they had to give him a trach…he had a feeding tube down his nose, he kept pulling out. He knew who I was, but he didn’t know where he was or where he lived…his suffered for 3 months and he was actually doing better and could sit up in a chair with a lot of help. And he was weaning off the vent for 24 hours They had put him in a rehab hospital. He got dehydrated and sent back to ER they put him back on the vent. They found the cancer…he was sent back to rehab…he never rallied again. He screamed and fought all time, they had to tie him down so’s he wouldn’t pull things out. They tried getting him off the vent again but he just fought them and wouldn’t do it. He wouldn’t last 5 minutes off the vent without screaming that he couldn’t breathe…well he couldn’t. He wouldn’t sit up anymore. I didn’t know what to do. He wanted to come home…but he couldn’t come home. What they were doing for him was extraordinary in keeping him alive. I called Hospice…they came and took him to their facility and took him off the vent and the feeding tube he died in a 1/2 an hour. The hospital he was at was a Catholic hospital. I believe I did the right thing. Reading this thread has made me confused about what happened to my husband. I don’t know why I’ve written this down. Maybe I needed too. But I was told I did the right thing. All family members agreed. I’m not so sure anymore I guess.