Do not Resuscitate orders

[mosher]

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.

While a living will is not in and of itself immoral as it is only a testament of instructions made by a person or couple for various purposes from what is to be done with probate goods to providing instruction to Power of Attorney containing the same and instructions concerning End of Life issues. I would agree with the BC Province that they are not always a good set of instructions since they may lack form (especially since today many people can just write one themselves - which has little to no legal baring). However, if it is a true living will in that it was drawn by a lawyer and registered with the governing authority (in the US it is usually the county) then it has the force of law and unless there is a separate governing law (as you say there is in BC) then it is a binding instruction. However, the problem occurs when a beneficiary of the estate contests the will or living trust (as they cannot contest an irrevocable trust) and so responsibility is given to a judge until the case is heard. It can get very messy at times.

 

[paramedicgirl]

But isn’t it true, and correct me if I’m wrong, that the Church does not approve of living wills?

 

[mosher]

But isn’t it true, and correct me if I’m wrong, that the Church does not approve of living wills?

I am not aware of any such disapproval. The problem comes as with all things in the application and intention. It also depends on how you define “living will.” In Canada I am not aware of their structure but only as they exist in the US. So, in effect we could be speaking about two different animals. The American version of a living will is only a list of instructions to be carried out by the executors and other officials governing the remaining estate on particular issues. Usually it is a method to keep the estate out of probate courts in order to protect the family. In the US a will is established for protection from and not just protection of something. However, the instructions themselves can be immoral and each instruction must be looked at with an eye on the moral category to which each instruction is related.

 

[godbless]

But isn’t it true, and correct me if I’m wrong, that the Church does not approve of living wills?

Yes, the Church encourages living wills and durable powers of attoney. A living will is a worthless document in the hospital setting. Hospitals don’t ask people about living wills. A durable power of attorney would be used if the patient is not able to express his/her own wishes in a particular circumstance. Basically, without one the next of kin have this perogotive.

A DNR or NO CODE status is something that one requests a doctor to order when one is in the hospital. This states that one does not want to be revived in the event of respiratory failure or cardiac arrest. These people are almost always elderly, or with multiple medical problems. They are not refusing all treatment, but they don’t want to receive extraordinary treatment in the event that “all systems fail”. A doctor has to order a DNR status, the medical personel at the hospital must assume the patient is a FULL CODE unless there is a specific doctor’s order for a NO CODE.

For those who don’t know it, a CODE is what is inititiated in the hospital for patients who go into a fatal arrythmia or respiratory failure. Respiratory failure would require intubation and ultimately ventilator support. A cardiac arrhymia can originate from various causes, and requires either defibrillation and drug therapy to restart the heart, then a differential diagnosis to correct the cause.

 

[godbless]

Another thing I mght add is that I think the negative speculation here is totally unfounded. DNR orders are absolutely not abused in the hospital and in the hospital is the only place they really exist, other than perhaps a long term care facility. The fact of the matter is that it’s a bigger problem that many people don’t have the courage to face the medical futility of their or their loved one’s condition and medical workers are forced to perform codes on patients who had very poor neurological outcomes and ended up dying soon afterwards anyways. It is a very traumatic thing for hospital workers to be involved in a futile code on a 90 year old patient.

 

[ElizabethPH]

The American version of a living will is only a list of instructions to be carried out by the executors and other officials governing the remaining estate on particular issues. Usually it is a method to keep the estate out of probate courts in order to protect the family. In the US a will is established for protection from and not just protection of something. However, the instructions themselves can be immoral and each instruction must be looked at with an eye on the moral category to which each instruction is related.

A living will is a legal document in which you state the kind of health care you want or don’t want under certain circumstances.

Please see difinition in Wikipedia

en.wikipedia.org/wiki/Living_will

 

[godbless]

A living will is a legal document in which you state the kind of health care you want or don’t want under certain circumstances.

Please see difinition in Wikipedia

en.wikipedia.org/wiki/Living_will

If you want your wishes carried out in a certain way, the best thing to do is have a discussion with a loved one and if you are of like mind with that person, then designate them as your durable power of attorney in the event you lose your ability to state your specific treatment choice in the event that you are incapacitated.

An even better way is to discuss this with your medical doctor. Many places are having people fill out POLST forms. These forms are Phycision Orders for Life Sustaining Treatment. They are simple forms that have specific catagories pertaining to one’s wishes. They address whether one wishes mechanical ventilation, cardiac defibrillation,artificial nutrition, antibiotic therapy, etc. You check off your wishes, and the physician signs it. You can change your mind at any time. This form can be kept on your refrigerator to inform emergency medical personel as to your wishes. The hospital will inquire if you have one on admission.

 

[ElizabethPH]

If you want your wishes carried out in a certain way, the best thing to do is have a discussion with a loved one and if you are of like mind with that person, then designate them as your durable power of attorney in the event you lose your ability to state your specific treatment choice in the event that you are incapacitated.

An even better way is to discuss this with your medical doctor. Many places are having people fill out POLST forms. These forms are Phycision Orders for Life Sustaining Treatment. They are simple forms that have specific catagories pertaining to one’s wishes. They address whether one wishes mechanical ventilation, cardiac defibrillation,artificial nutrition, antibiotic therapy, etc. You check off your wishes, and the physician signs it. You can change your mind at any time. This form can be kept on your refrigerator to inform emergency medical personel as to your wishes. The hospital will inquire if you have one on admission.

Thanks for the info…but I was confused at mosers definition of a living will…it seems to me he’s confused it with a living trust or some such as a way for families to avoid probate…which if my thinking is right doesn’t have anything to do with living wills. But maybe it’s me and I just can’t understand the way he expresses himself.

 

[rwoehmke]

Some years ago I was an Emergency Medical Technician. Our volunteers had an understanding that when we knew someone had not had a pulse for four or five minutes, we did not even attempt CPR. We worked in a rural are and as it took as much as ten or fifteen minutes to get to even close emergencies that was our rule of thumb. This was long before we were equpped with defibrilators. I owe my last three years to an EMT crew who arrived in two minutes with a defib. and some divine intervention. We were out of town in a hotel in the same block as the firehall with full time paramedics. If I had been home I would have met my Lord.

 

[Karin]

Thanks for the info…but I was confused at mosers definition of a living will…it seems to me he’s confused it with a living trust or some such as a way for families to avoid probate…which if my thinking is right doesn’t have anything to do with living wills. But maybe it’s me and I just can’t understand the way he expresses himself.

Not just you…a WILL is for when you are dead and in how to dispose of your estate etc.
A LIVING WILL is something totally different.

 

[BLB_Oregon]

Could I pop in an reiterate my understanding, so I could get this clarified? As I understand it, the morality of a DNR has nothing to do with your age. It has to do with whether or not death is imminent or whether or not extraordinary means are especially likely to cause adverse outcomes in the patient. We are not morally bound to do a resuscitation that, while it may extend the life of the patient for a limited amount of time, also raises the real danger of doing injury to the patient from which they are unlikely to recover or to introduce unnecessary suffering into the process of death.

My grandfather, for instance, had a heart that was seriously failing. On the day he died, CPR and defibrillation might have given him another month. Or another day. Or it may not have worked at all. Grandpa had undergone those treatments in his past. At the time, these interventions gave him years of extended life. Nevertheless, he knew them to be extremely painful. CPR can break ribs. Grandpa likened defibrillation to being kicked by a horse. He knew he was dying, and he didn’t want that kind of a death.

It is my understanding that we are not morally bound to do that stuff to a patient who cannot expect anything but a lengthening of their death process as a result. Insisting upon resuscitation under all circumstances almost guarantees that no terminal patient who comes anywhere near a hospital will ever be allowed to die a peaceful death.

OTOH, when he collapsed several years before that, he may have died in spite of those painful resusciation efforts. He would have asked for them anyway, though, because in that case they had a chance to do some real good. He was already advanced in years at that time, but he did not have a heart condition that was imminently terminal. He would say that while life is a choice, you choose life, even if you chance having a harder life or a less-peaceful death than you would otherwise want.

Being frail or having a bad heart or a combination of failing organs isn’t, in and of itself, a reason for a DNR. Even when life gets hard, life is still worth living. But there gets to be a time when your choice is not how you will continue to endure your problems, but how you will choose to approach and journey through your death. At that point, a DNR is not a denial of life, but a recognition that the process of dying is a part of the work of living.

Obviously, there is not a bright and easy-to-recognize line between the two cases. It is a question that requires serious discernment in each case.

I would welcome comments, in way of clarification or correction.

 

[mosher]

Could I pop in an reiterate my understanding, so I could get this clarified? As I understand it, the morality of a DNR has nothing to do with your age. It has to do with whether or not death is imminent or whether or not extraordinary means are especially likely to cause adverse outcomes in the patient. We are not morally bound to do a resuscitation that, while it may extend the life of the patient for a limited amount of time, also raises the real danger of doing injury to the patient from which they are unlikely to recover or to introduce unnecessary suffering into the process of death.

My grandfather, for instance, had a heart that was seriously failing. On the day he died, CPR and defibrillation might have given him another month. Or another day. Or it may not have worked at all. Grandpa had undergone those treatments in his past. At the time, these interventions gave him years of extended life. Nevertheless, he knew them to be extremely painful. CPR can break ribs. Grandpa likened defibrillation to being kicked by a horse. He knew he was dying, and he didn’t want that kind of a death.

It is my understanding that we are not morally bound to do that stuff to a patient who cannot expect anything but a lengthening of their death process as a result. Insisting upon resuscitation under all circumstances almost guarantees that no terminal patient who comes anywhere near a hospital will ever be allowed to die a peaceful death.

OTOH, when he collapsed several years before that, he may have died in spite of those painful resusciation efforts. He would have asked for them anyway, though, because in that case they had a chance to do some real good. He was already advanced in years at that time, but he did not have a heart condition that was imminently terminal. He would say that while life is a choice, you choose life, even if you chance having a harder life or a less-peaceful death than you would otherwise want.

Being frail or having a bad heart or a combination of failing organs isn’t, in and of itself, a reason for a DNR. Even when life gets hard, life is still worth living. But there gets to be a time when your choice is not how you will continue to endure your problems, but how you will choose to approach and journey through your death. At that point, a DNR is not a denial of life, but a recognition that the process of dying is a part of the work of living.

Obviously, there is not a bright and easy-to-recognize line between the two cases. It is a question that requires serious discernment in each case.

I would welcome comments, in way of clarification or correction.

I think this is a perfect synopsis that expresses a clear understanding of the issue. Well done.