Do not Resuscitate orders

[Pug]

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.

Elizabeth,

If you can, return to being at peace about your husband! I don’t want some thread here to upset you in this way. You did your very best by him, I’m sure! We here don’t know every detail of what happened with your husband, so if you are worried, talk to a priest. He can listen to all the details and help you reach peace. Death can bring up many issues, and we can so easily feel guilty where we ought not. It sounds like you experienced many difficult situations during your husband’s last weeks of life. I am so sorry for your loss of your husband.

As far as I know, a respirator is not always required care. There can be times when one need not accept a respirator. Furthermore, there can be times when it is just fine to remove one that is already hooked up. I know yours was a real life situation, so I worry about saying too much more, since I am not there to see your face nor you mine. Loving words are hard to hear over the internet.

 

[maggieodae]

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.

My husband died in December. My priest advised me to not sign the DNR and take it one day at a time. That is how I handled it and am glad that I did it that way.

 

[Coop73]

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

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.

****Dear ElizabethPH,
I am so sorry this has brought up painful feelings. I never meant to hurt anyone and I will pray for you. Like I said I am new to the Catholic faith but surely the hospital being a Catholic based hospital wouldn’t advise the wrong thing. Again, I am so sorry for the pain you are feeling. I did not think of this hurting others, I wish I had not even asked it and could take it back.

 

[ElizabethPH]

****Dear ElizabethPH,
I am so sorry this has brought up painful feelings. I never meant to hurt anyone and I will pray for you. Like I said I am new to the Catholic faith but surely the hospital being a Catholic based hospital wouldn’t advise the wrong thing. Again, I am so sorry for the pain you are feeling. I did not think of this hurting others, I wish I had not even asked it and could take it back.

Don’t feel like that Coop. I’m apologize for getting so emotional. I was just surprised and confused at some of the responses. I hope that you are not more confused about your circumstance which I know is so hard on your family. You were just searching for some answers. For myself I will take Pugs advice and seek out a priest, as I still obviously am struggling.

 

[maggieodae]

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.

You did just fine. A vent is not required when things go that far south. My dh was much the same. He fought the cancer battle over and over but in the end he could not win.

He suffered terribly the last few months and fought to pull out all the tubes etc. the last hospital stay. We took it one day at a time. When he got to the point he got out of bed by pulling out all the tubes, and fell, injuring himself badly, we just used the best judgement we could make.He bit his tongue, broke his nose and cracked his head, which lead to another CT scan. The scan revealed the cancer was in his brain as well as throughout his body. They had been going to start chemo the next day, which would have been useless and put him through more pain than it would help him.

My priest and I agreed that only the oxygen and the IV for hydration and administering pain meds, would be used from then on. We got a special bed brought in so he could not get out of it and hurt himself more. We stayed with him round the clock, and made sure he was comfortable with the meds for pain. The last 4 days he was pretty much in coma, but woke up at 3:30 PM…said: “Jesus I Trust in you.” and he went home to Eternity.

Don’t beat yourself up over doing the best job you could. You did all that was required of you and you did it with Love.

 

[BLB_Oregon]

My husband died in December. My priest advised me to not sign the DNR and take it one day at a time. That is how I handled it and am glad that I did it that way.

I’m sorry about your husband. My husband’s father and grandfather died relatively young. I have always dreaded going through what you’ve described. My heart goes out to you.

Whether or not a DNR is appropriate depends on the patient and the situation. Sometimes, just having the decision-maker “on-call” to take the medical decisions one day at a time is the way to go. Not easy, but the best thing. Anyone who is considering signing one for themselves or for a loved one for whom they have legal medical authority might really consider finding someone to explain this who understands both the practical medical aspects and the Catholic moral side of these orders, so that the discussion can take place in light of the particular patient’s medical realities.

This is always a hard thing. It is desirable to give life every chance, but not necessarily moral in every medical case to “do everything”. The objective of moral DNRs, after all, is to avoid medical interventions which will primarily serve to prolong or intensify the suffering and prevent the peaceful approach of a death God has ordained to take place. At any rate, it is best for everyone’s health and peace of mind if the decision is not taken on alone. Just because the decision gives the decision-maker some peace, too, would not make it wrong.

I have found that the Catholic health professionals who are fully versed on DNRs are usually more than happy to spend the time to fully explain them to people going through that difficult decision. A person going through this should not think that they are bothering them. If someone doesn’t know who to trust, their pastor can usually make a suggestion.

 

[mosher]

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 know, that is exactly what I am saying. And in order for the Doctor to act ethically he would have to resuscitate. I am not speaking about popular medical ethics but rather of objective natural moral law ethics which is controlling. If a doctor in this case did not resuscitate even if the medical community as stated otherwise his immortal soul is in jeopardy.

.
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.

Exactly, and this is why a DNR interpreted in the narrow view of the popular medical world is intrinsically immoral. Hence the reason why there is a serious danger with having a DNR in this time in history. For this reason it is much safer to have a “health care decision maker” as I stated in the above post. This eliminates the doctor and the medical ethical board of the hospital from making decisions that they are not qualified to make.

 

[oldfogey]

I know, that is exactly what I am saying. And in order for the Doctor to act ethically he would have to resuscitate. I am not speaking about popular medical ethics but rather of objective natural moral law ethics which is controlling. If a doctor in this case did not resuscitate even if the medical community as stated otherwise his immortal soul is in jeopardy.

Exactly, and this is why a DNR interpreted in the narrow view of the popular medical world is intrinsically immoral. Hence the reason why there is a serious danger with having a DNR in this time in history. For this reason it is much safer to have a “health care decision maker” as I stated in the above post. This eliminates the doctor and the medical ethical board of the hospital from making decisions that they are not qualified to make.

Mosher, you are incorrect and I believe at this point you are misleading those who are struggling with this issue, especially as you are stating that a DNR is immoral, and that for a medical person to follow it is against natural law.

Again, for an elderly person with chronic medical problems, resuscitation restores vital functions 3% of the time, that’s 3 times in a hundred, and half of the survivors have severe impairments. What happens to the other 97%? From experience, I will tell you that the paramedics usually know the person has passed at the scene, but they do not tell the family. They then transport the person to the Emergency Room, where they are pronounced. This is NOT death with dignity.

As for natural law, a person has the right to decide that they will refuse a medical procedure which has only a small chance of success, which means that CPR can be refused (see above paragraph.) You seem to think that other people (a doctor) has some moral duty under natural law to contravene this decision. Which part of “DO NOT RESUSCITATE” is unclear here?

 

[Linuse]

Having worked as en emt on an ambulance for ten years, there are some things wrong with what oldfogey says.
Different states have different laws regarding DNR orders.
The laws are also similar but different for ambulance personel than for hospitals.
For ambulance personel–the DNR order must be present, not just someone telling you that there is one. In Wi. where I started, it had to be on the person in a bracelet packet that could not be removed except by cutting. If it was cut off–it was no longer valid. In Ks. there only had to be a copy of it at the scene.
Secondly, we were not allowed to transport an obviously dead body. We would make exceptions to this when circumstances demanded it–but you better be able to defend your reasoning.
Protocol demanded moving the body in the case of infant death syndrome.
If there was an outside chance of revival, then do CPR/defib and transport. If a DNR is presented–then no.

 

[BLB_Oregon]

Having worked as en emt on an ambulance for ten years, there are some things wrong with what oldfogey says.
Different states have different laws regarding DNR orders.
The laws are also similar but different for ambulance personel than for hospitals.
For ambulance personel–the DNR order must be present, not just someone telling you that there is one. In Wi. where I started, it had to be on the person in a bracelet packet that could not be removed except by cutting. If it was cut off–it was no longer valid. In Ks. there only had to be a copy of it at the scene.
Secondly, we were not allowed to transport an obviously dead body. We would make exceptions to this when circumstances demanded it–but you better be able to defend your reasoning.
Protocol demanded moving the body in the case of infant death syndrome.
If there was an outside chance of revival, then do CPR/defib and transport. If a DNR is presented–then no.

This puts the decision about DNR with the patient…where it belongs. Since there are cases in which a DNR order is morally appropriate according the teachings of the Church, these orders should be available and always immediately rescindable by the patient or their legal representative.

As a counter-example, a euthanasia order would always be morally inappropriate and should never be made legal. We are only talking about a patient’s right to refuse treatment, not any right to have cooperation in suicide. Those are entirely different kettles of fish.

 

[mosher]

Mosher, you are incorrect and I believe at this point you are misleading those who are struggling with this issue, especially as you are stating that a DNR is immoral, and that for a medical person to follow it is against natural law.

Again, for an elderly person with chronic medical problems, resuscitation restores vital functions 3% of the time, that’s 3 times in a hundred, and half of the survivors have severe impairments. What happens to the other 97%? From experience, I will tell you that the paramedics usually know the person has passed at the scene, but they do not tell the family. They then transport the person to the Emergency Room, where they are pronounced. This is NOT death with dignity.

As for natural law, a person has the right to decide that they will refuse a medical procedure which has only a small chance of success, which means that CPR can be refused (see above paragraph.) You seem to think that other people (a doctor) has some moral duty under natural law to contravene this decision. Which part of “DO NOT RESUSCITATE” is unclear here?

This is not correct. The only thing a person as a right to refuse is an medical procedure that is considered extraordinary means. Extraordinary means (rather simplistically explained) is a procedure that is 1. over-burdensome to the patient and has no chance of stopping the speedy decline of health and 2. Is a grave financial overburden to the family with little chance of recovery.

Even if there is a 1% chance of keeping a person alive and it does not fit into extraordinary means then it is morally required… So, yes the current interpretation of DNRs in the medical profession are intrinsically immoral. However, DNRs in an of themselves are not immoral unless they violate these basic bioethical principles that are easily accessed in the book “Catholic Bioethics” by William May the foremost authority on these issues.

You are also missing the precision of my language. I never stated (as I just mentioned) that DNRs are immoral in themselves but rather that the current medical ethical interpretation by most hospitals in executing DNRs is immoral as it does not err on the side of life but rather errs on the side of death which is not a moral error. Also, I did not say that executing a DNR is immoral but rather executing a DNR as I just described is immoral and in fact is the sin of murder levied on those who are responsible. For these reasons it is important to not have a DNR in the current climate but rather a Health Care Power of Attorney which is not subject to interpretation as it is an actual person making the decisions wresting that decision from the ethical board of a hospital or individual doctor who may not be properly formed in objective ethics.

 

[BLB_Oregon]

For these reasons it is important to not have a DNR in the current climate but rather a Health Care Power of Attorney which is not subject to interpretation as it is an actual person making the decisions wresting that decision from the ethical board of a hospital or individual doctor who may not be properly formed in objective ethics.

In the absence of a condition that is undeniably terminal, I totally agree with you. Catholic application of DNRs will occur in a much more narrow range of cases. Old age alone is not sufficient cause for a DNR.

Nevertheless, there gets to be a time when death is imminent and at which it is ethical to come to the conclusion that no more efforts at resuscitation should be employed. If the progression of death has reached the point that the patient’s spouse or the person with power of attorney is going to have to sit by the patient’s deathbed and throw themselves in the way of inappropriate interventions, a DNR is appropriate.

The patient may be totally conscious and still come to this conclusion themselves. When my grandfather was in the end-stages of congestive heart failure back in the late '70s and there was no surgical intervention likely to repair his condition, he made a directive that was essentially a DNR. He let it be known in no uncertain terms that he did not want to undergo CPR or defibrillation again. He directed his family to pray that he have a peaceful death, which he did. Had a hospice or home hospice care been available at the time, he undoubtedly would have elected to die outside the hospital, preferably at home.

 

[mosher]

In the absence of a condition that is undeniably terminal, I totally agree with you. Catholic application of DNRs will occur in a much more narrow range of cases. Old age alone is not sufficient cause for a DNR.

Nevertheless, there gets to be a time when death is imminent and at which it is ethical to come to the conclusion that no more efforts at resuscitation should be employed. If the progression of death has reached the point that the patient’s spouse or the person with power of attorney is going to have to sit by the patient’s deathbed and throw themselves in the way of inappropriate interventions, a DNR is appropriate.

The patient may be totally conscious and still come to this conclusion themselves. When my grandfather was in the end-stages of congestive heart failure back in the late '70s and there was no surgical intervention likely to repair his condition, he made a directive that was essentially a DNR. He let it be known in no uncertain terms that he did not want to undergo CPR or defibrillation again. He directed his family to pray that he have a peaceful death, which he did. Had a hospice or home hospice care been available at the time, he undoubtedly would have elected to die outside the hospital, preferably at home.

Correct. If it is medically sure that death is immanent then such a case is moral.

 

[maryj]

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.

May God bless and keep your mother strong. caregiving is one of the hardest jobs a person will ever be called to do, let alone trying to make decisions like this. Pray, ask your mother to pray, He will tell you, you will know when the answers are right.Get to Adoration, listen, ask, Jesus Christ will be your guide. My mother is 88, I have 10 siblings, She had multiple strokes, and congestive heart failure thispast summer. I have POA, and we have a medical directive, I make the decisions about her care. She was very specific about this with me, DO not resesitate. I have brothers and sisters who are very angry with me for signing a DNR, it was her decision, I spent time on my knees in front of the Holy Eucharist in Adoration. I know I’ve made the right decisions. She continues to live at home with help from me and my family, (my husband is a saint) I have no problems with the decisions we made, Just ask for a little help from above. I shall pray for your mother. God Bless You.

 

[godbless]

A DNR order is a personal preference that is the perogative of each person. There’s nothing wrong with it. Very often people who are revived are cognitively impaired and some people don’t want to fact that. They want to die naturally. It has nothing to do with Euthaniasia which is actively taking someone’s life. It only means that medical personal are not allowed to attempt a code on the patient but that if they stop breathing or their heart stops then they should be pronounced dead.

There is nothing about making this choice morally wrong. You might disagree with someones choice but you have to respect it. People who are upset with the culture of death should not be afraid of this. Our complicated medical technology has neccessitated this choice on people’s parts, since medicine can totally strip about the dignity of the human person sometimes.

 

[paramedicgirl]

This is not correct. The only thing a person as a right to refuse is an medical procedure that is considered extraordinary means. Extraordinary means (rather simplistically explained) is a procedure that is 1. over-burdensome to the patient and has no chance of stopping the speedy decline of health and 2. Is a grave financial overburden to the family with little chance of recovery.

Even if there is a 1% chance of keeping a person alive and it does not fit into extraordinary means then it is morally required… So, yes the current interpretation of DNRs in the medical profession are intrinsically immoral. However, DNRs in an of themselves are not immoral unless they violate these basic bioethical principles that are easily accessed in the book “Catholic Bioethics” by William May the foremost authority on these issues.

You are also missing the precision of my language. I never stated (as I just mentioned) that DNRs are immoral in themselves but rather that the current medical ethical interpretation by most hospitals in executing DNRs is immoral as it does not err on the side of life but rather errs on the side of death which is not a moral error. Also, I did not say that executing a DNR is immoral but rather executing a DNR as I just described is immoral and in fact is the sin of murder levied on those who are responsible. For these reasons it is important to not have a DNR in the current climate but rather a Health Care Power of Attorney which is not subject to interpretation as it is an actual person making the decisions wresting that decision from the ethical board of a hospital or individual doctor who may not be properly formed in objective ethics.

Mosher, please help me to understand how a DNR for a terminally ill patient or an elderly person who is at the natural end of their life is immoral.

Where I live, these are the only two categories of patients who are allowed to sign a DNR. Almost all patients who sign a DNR have terminal cancer, in my experience. Once their heart stops, it is unlikely we will be able to resuscitate them.

 

[mosher]

Mosher, please help me to understand how a DNR for a terminally ill patient or an elderly person who is at the natural end of their life is immoral.

Where I live, these are the only two categories of patients who are allowed to sign a DNR. Almost all patients who sign a DNR have terminal cancer, in my experience. Once their heart stops, it is unlikely we will be able to resuscitate them.

It would not be in such a case since the term terminal means that there is no way to keep this person alive without using extraordinary means. I am speaking more broadly on this issue. In some states as my own a DNR can be part of a living will and in such cases where a person has a heart attack they are not revived even though it is possible with little to no harm because the DNR is in place - this would be an immoral use.

A DNR order is a personal preference that is the perogative of each person. There’s nothing wrong with it. Very often people who are revived are cognitively impaired and some people don’t want to fact that. They want to die naturally. It has nothing to do with Euthaniasia which is actively taking someone’s life. It only means that medical personal are not allowed to attempt a code on the patient but that if they stop breathing or their heart stops then they should be pronounced dead.

There is nothing about making this choice morally wrong. You might disagree with someones choice but you have to respect it. People who are upset with the culture of death should not be afraid of this. Our complicated medical technology has neccessitated this choice on people’s parts, since medicine can totally strip about the dignity of the human person sometimes.

Error cannot be respected in such a case for the sake of their immortal soul. A person that puts into place a DNR that will not be interpreted under strict bioethical principles is putting both their soul and the soul of the practitioner in jeopardy.

From this post I don’t think that you have a firm grasp of what is meant by “the dignity of the human person.” Under catholic principles a person such as in the case of Terry Schievo has the same dignity as you or I. The quality of life is not measured on the burden placed on the person nor on their material value. The dignity of a human person is judged based on the merit that they are able to live or not live. In all cases life is preferable to death despite an individuals preference. A person that would rather be allowed to die than suffer as a result of legitimate resuscitation is an ill-formed conscious and it is the obligation of the Church to help form it properly. In this light the Church has spoken very clear that dignity is not equated to the modern notion of “quality of life.”

 

[paramedicgirl]

It would not be in such a case since the term terminal means that there is no way to keep this person alive without using extraordinary means. I am speaking more broadly on this issue. In some states as my own a DNR can be part of a living will and in such cases where a person has a heart attack they are not revived even though it is possible with little to no harm because the DNR is in place - this would be an immoral use.

I agree that living wills are immoral, and I thank God that my employer, the Province of British Columbia, will not allow paramedics to acknowledge living wills.

 

[godbless]

A Living Will is a worthless document that has no influence on medical personel. There is nothing morally wrong with anyone requesting that they not be resuscated with cardio pulmonary resucitation or advanced cardiac life support. If there is any doubt and lack of evidence, no medical practitioner in the world will opt to withhold emergency life support measures from patients. They can’t do it without a doctor’s order.

From what I’m reading here there seems to be quite a bit of ignorance and misrepresentation of the Catholic position here. Advanced Cardiac Life Support methods are extraordinary means. Any person has a right to put into writing that they don’t want this to happen to them if they go into respiratory or cardiac failure.

This isn’t going to affect some young guy out in the field who gets zapped by lightening and goes into cardiac arrest. This affects very ill people in the hospital who have a right to refuse to be revived. Grandma has a right to make this decision for herself without a big argument from her family. She has a right to say that she’s lived a good life and will accept death as it comes. She also has a right to choose for all means to be used to preserve her life. It’s her choice.

Everyone should think about this question.

 

[mosher]

A Living Will is a worthless document that has no influence on medical personel. There is nothing morally wrong with anyone requesting that they not be resuscated with cardio pulmonary resucitation or advanced cardiac life support. If there is any doubt and lack of evidence, no medical practitioner in the world will opt to withhold emergency life support measures from patients. They can’t do it without a doctor’s order.

From what I’m reading here there seems to be quite a bit of ignorance and misrepresentation of the Catholic position here. Advanced Cardiac Life Support methods are extraordinary means. Any person has a right to put into writing that they don’t want this to happen to them if they go into respiratory or cardiac failure.

This isn’t going to affect some young guy out in the field who gets zapped by lightening and goes into cardiac arrest. This affects very ill people in the hospital who have a right to refuse to be revived. Grandma has a right to make this decision for herself without a big argument from her family. She has a right to say that she’s lived a good life and will accept death as it comes. She also has a right to choose for all means to be used to preserve her life. It’s her choice.

Everyone should think about this question.

Again, there is a lack of precision in your statements. A person does not have a right do do something immoral or to direct another to do something immoral. The situations that you present while in most cases would be a moral application for a DNR it does not mean that it is moral in all instances. The principles that govern this aspect of morality must be stated in such a specific way that it is careful to address this issue.

There is a further problem. If a person has a particular terminal illness or some sort and is in the hospital or on hospice and they need resuscitation due to some problem that is not related to the primary illness it would still be necessary to resuscitate that person if possible even though the other illness is terminal and the option to not resuscitate the person is moral if in conjunction with the terminal illness. However, many practitioners will not recognize this distinction and hence another reason why a DNR is a moral risk. Rather as I have said before, and as has been advised to me by some of the top Catholic Bioethicists in country, it is better to have a “Heath Care Decision Maker” other wise known as “Heath Care Power of Attorney” as a person to make those decisions if the person themselves is incapacitated. This is not the same as a Power of Attorney or Trustee in a Trust who has control over funding but rather a separate person who makes all and only the medical decisions if necessary.

Further, a living will and ever more a Living or Irrevocable Trust are not worthless. A DNR or any other instructions contained have the force of law unless determined otherwise by the courts. While a living will can be contested an Irrevocable Trust cannot and if instructions are contained therein (unless it is not possible) a doctor or health care professional can be held libel if they do not follow End of Life instructions contained within the duly registered documents.