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Discussion Starter · #1 ·
Just in case you don't know, here's the meaning of the word from Merriam-Webster.<br><br><br><br><i>Resuscitate-To revive from apparent death or from unconsciousness</i><br><br><br><br>
Say an older person (early 60's) close to you is in the hospital and could possibly die. This person has asked you sign documents (being that you are next of kin) that you are in agreement with her wishes to not be resuscitated (also known as a DNR order). This person also has a living will stating that her body not be kept alive on any machines in the case of being deemed clinically brain dead.<br><br><br><br>
I need to know how you feel about DNR orders. Would you sign the order out of respect for this person's wishes even though you feel that you shouldn't? Would you help this person 'throw in the towel'? Would you try and talk to this person to try and change how they feel about not being saved from death or would you quietly sign the papers? Or would you feel selfish not signing the order; after all it's not your life to make decisions on. Any thoughts or input would be appreciated.
 

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Discussion Starter · #2 ·
I work with the elderly (Adult Protective Services), so this is a incredibly common question for me. I know that, for family members, the DNR advanced directive is frightening and perplexing, but we've all got to remember one thing: adults are just that--adults. They have the right to their own autonomy and agency, the right to make their own decisions, even if we find those decisions to be questionable or poor. It ultimately is the person's choice, and I feel that loved ones should respect their family members choice and do their very best to advocate for those choices...
 

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Discussion Starter · #3 ·
Oatmeal-There is a very high probability that this person could die during open heart surgery in the very near future. She's in the hospital currently with a menu of illnesses; the most life-threatening being endocarditis (an infection of the heart). A heart valve that was replaced 15 years ago has deteriorated and needs attention asap. They can't operate though until the infection is clear, which could be another 4-6 weeks.<br><br><br><br>
FemmeDemonica-Thank you so much. I find myself wanting to be protective and in the process somehow I've lost sight of the fact that she is an adult and still capable of making her own decisions. It's hard to let go. But I shouldn't make it any harder for her by questioning her decisions. It's got to be a very difficult for her as it is. I will try and remain positive and sign off on whatever she wishes.<br><br><br><br>
Thank you again.
 

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Discussion Starter · #4 ·
I wouldn't sign anything that I didn't believe in.<br><br><br><br>
If I had a problem with DNR orders, I would refuse to sign. It would be unfair to say I would do something, and then not do it.<br><br><br><br>
Therefore, if I had signed the documents agreeing with the DNR order, I would follow through with it since I had already previously indicated that I was ok with it.
 

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My mother at the end of her life was suffering greatly. She could not breath on her own and couldn`t even get out of bed. The last time she went into the hospital she begged us not to resuscitate her if she started to pass away. It was hard for our family but we respected her decision. She passed away peacefully in her sleep.
 

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Discussion Starter · #7 ·
<b>**A new thread for the discussion of euthanasia (prompted by Oatmeal's post) has been created in the Compost Heap.</b>
 

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Oh, I'm sure this must be so hard for you! I hope you can come to terms with your mother's wishes. She has to make her own decisions but it's got to be difficult for you to think of letting her go. My mom works with elderly people and we talk about this sort of thing often. She is of the mind that you have to allow people to have their dignity and make their own decisions. I agree. Big hugs to you!
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by Gruntled Sheep</i><br><br><b>I wouldn't sign anything that I didn't believe in.<br><br><br><br>
If I had a problem with DNR orders, I would refuse to sign. It would be unfair to say I would do something, and then not do it.<br><br><br><br>
Therefore, if I had signed the documents agreeing with the DNR order, I would follow through with it since I had already previously indicated that I was ok with it.</b></div>
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Good point. When you are looking for someone to be a proxy decision maker, you should choose someone that not only you trust, but that you feel agrees with your decision and is OK with it.<br><br><br><br>
Respecting that a person is an adult and has autonomy is not the same as thinking they are making a choice you agree with.<br><br><br><br>
Anyway, by signing the forms, this is an agreement to be a health care decision making proxy, the person who makes decisions accd to the living will and where there are grey areas. A person doesn't need anyone to "approve" by signing when creating just an DNR. If one has a DNR, they should make sure they have it in their medical records, and might even want to wear a bracelet.<br><br><br><br>
So MsRuthie-<br><br>
If you feel it would be hard for you to be in this position, then the best thing you can do for them is to encourage the person to find someone else. You can't change the person's wishes, but you don't have to agree, nor sign the form. This person is very sick and could die, I am assuming even with successful surgery, the person will still be sick the rest of their life, and may not have a good quality of life, correct? This is a sort of situation where it may be hard to try to ignore one's own feelings about losing the person, and focus only on what will be best for the loved one themselves.<br><br><br><br>
If you feel your loved one doesn't fully understand the ramifications of their wishes, you could advise them to talk to a physician. Living wills should be talked about with one, anyway. But it sounds like that is unecessary.<br><br><br><br>
On the other hand, if I had a relative who was in good health, good quality of life and just didn't want to be resuscitated, I wouldn't agree with it. This would mean if they were drowning, no CPR, if they had a heart attack, no defibrillator, etc.<br><br><br><br>
If someone is clinically brain dead, they are legally dead anyway, and would not need a living will to get off the machines, so you wouldn't have to worry about that.
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by MsRuthieB</i><br><br><b>I need to know how you feel about DNR orders. Would you sign the order out of respect for this person's wishes even though you feel that you shouldn't? Would you help this person 'throw in the towel'? Would you try and talk to this person to try and change how they feel about not being saved from death or would you quietly sign the papers? Or would you feel selfish not signing the order; after all it's not your life to make decisions on. Any thoughts or input would be appreciated.</b></div>
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Well, Ruthie, you asked for it. I'm gonna tell you about my Mom's death. They had a DNR on her. At the time here in Nashville, it did not require a signature from either my mother or myself (she had a living will, and a durable power of attorney for health care decisions, and I was the "decision maker" named in the durable power of attorney.) All that was involved was her doctor talking with her, asking her orally, getting an oral response from her, then checking a box on her chart.<br><br><br><br>
My mother had breast cancer. She was treated for it for four years, mostly on an outpatient basis, by Vanderbilt University Medical Center. She visited her doctor and they had a discussion about this DNR and she ok'ed it. When I spoke to the doctor, he told me that most people in my mother's condition had about a year to live.<br><br><br><br>
About six weeks later, my mother developed difficulty breathing one weekend. We tried to call the doctor and the hospital, but got the run-around. The visiting nurse came on Monday. She said: "I don't know what's wrong, but your mother needs to go to the hospital." So, we called an ambulance. I rode with my mother in the ambulance. The ambulance broke down several times on the way to the hospital. In fact, we were within about six blocks of the hospital when it broke down so completely that they had to bring up a second ambulance and transfer my mother to that one to make the final leg of the journey.<br><br><br><br>
My mother finally gets to the hospital, and they direct the ambulance driver and assistant to take her to an examining room. The ambulance driver says: "What? You don't want me to take this woman to the emergency room?"<br><br><br><br>
She gets taken to an examining room then to a hospital room. The doctors say something about a blood clot in the lungs, but they will need to do more tests the next day. They are very insistent about confirming the DNR, however.<br><br><br><br>
My mother asks me to help her get to the bathroom, about 8 pm. So I take her arm, help her walk in there, and then walk back.<br><br><br><br>
As soon as she gets back into bed, some nurses aides or whomever come into the room and insist they have to change the bedding immediately. Do they ask her to get out of bed to do this, and sit on the chair that is beside the bed? No. They start pushing her on her side, stripping off one half of the bed and putting new sheets on the bed, then rolling her over on the other side to do the other half of the bed, and shaking and shoving her like she was some sort of f*@king milkshake.<br><br><br><br>
It seems like they managed to dislodge the blood clot in her lungs, which travelled to her heart, and killed her instantly.<br><br>
And, of course, since they had the DNR, they did not try to revive her.<br><br><br><br>
Now, you can say that the DNR was irrelevant to what actually happened--that it would have happened anyway. Maybe so.<br><br><br><br>
But my feeling is that the DNR was used as a license by all the so-called "medical professionals" at Vanderbilt to treat my mother as a second class citizen from the instant she ok'ed it. They were "off the hook" from any responsibility because of the DNR, and they acted accordingly. My mother might as well have worn a sign around her neck that said: "Go ahead and treat me like sh`t; I have ok'ed a DNR."<br><br><br><br>
I would guess if you talked to doctors and other "medical professionals" they would deny all this and tell you that a DNR has no effect on the level or quality of care provided until or unless the patient--despite the best efforts of all the "medical professionals"--unfortunately lapses into a coma, unconsciousness, or some other state that would require resuscitation in the absence of a DNR. [BULL SH#T!]<br><br><br><br>
So, no, knowing what I know now, I would not sign or ok a DNR for someone I cared about, unless that person were in such pain and agony that bringing about their death quickly would be merciful. Yes, the person should have a living will and a durable power of attorney for health care--but a DNR is no substitute for these.<br><br><br><br>
P.S. In my mother's case, her death might well have been a "blessing in disguise." Had the lung blood-clot problem been overcome and had she lived that extra year, it would almost certainly have been a year of increasing pain and debilitation.<br><br>
So she might have been spared a great deal of pain and suffering by the way in which she died.
 

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Discussion Starter · #11 ·
Joe, Squirly, and MRB, I'm genuinely sorry about your mothers. <img alt="" class="inlineimg" src="/images/smilies/sad.gif" style="border:0px solid;" title=":("><br><br><br><br>
I would NEVER recommend DNR in place of a durable power of attorney or living will. I'm wondering now, though, does that durable POA override that patient's DNR? I have no clue. I'll have to ask around here...
 

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Discussion Starter · #12 ·
wow Joe. I'm so sorry you had to go through that. Thank you so much for sharing it. I'm definitely thinking about what you said in as far as the quality of care and treatment she receives if she signs a DNR. I'm thankful that she's at the Cleveland Clinic. They are known world wide for their medical expertise; especially when it comes to the heart. But I have noticed that they don't treat her as well as at the hospital they moved her from on Friday. She said she feels like just another number; like a job rather than a person. I wish I could stay with her during the day and help. So I'm worried that this may actually become worse if she signs the DNR. She has Osteogenesis Imperfecta (Brittle Bone Disease) also. The doctors said that the paddle things that are used to start the heart exert 30 lbs of pressure. They've said that the bones directly in contact with the paddles, and possibly some in the area of the paddles would most definitely break. As she gets older, it's harder for the bone's connective tissue to regenerate. Recouperating from that many breaks would be very painful and she doesn't want to go through it anymore. That is the underlying reason for not wanting to be resuscitated. I really can't relate because I don't have the disease and the only thing I've ever broke has been my nose.<br><br><br><br>
I need to look into the laws governing Ohio in regards to DNR's. Maybe I don't have to sign either? Maybe they are in a 'cover our butt' mode? I really don't see why I should be signing anything when she is capable of making a decision and signing herself. I wonder why her statement alone isn't enough? Hmmm..<br><br><br><br>
Thank you again Joe. I know it's hard to talk about and I really appreciate your sharing.
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by FemmeDemonica</i><br><br><b>... but we've all got to remember one thing: adults are just that--adults. They have the right to their own autonomy and agency, the right to make their own decisions, even if we find those decisions to be questionable or poor. It ultimately is the person's choice, and I feel that loved ones should respect their family members choice and do their very best to advocate for those choices...</b></div>
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I partly agree, but mainly disagree with the implications of this.<br><br><br><br>
Of course, patients are adults and have the right to make their own decisions.<br><br><br><br>
But a real "choice" implies "informed consent," and I believe that patients are not really giving "informed consent" because they are basically being lied to or misinformed or underinformed by doctors and other so-called "medical professionals." It is far more "convenient" for doctors and hospitals to have these DNRs on file than not to have them. The doctors are not an unbiased source of "information." Any patient should, in my opinion, consult with at least one independent attorney before signing their life away by signing a DNR. Do the doctors and other so-called "medical professionals" ever advise patients to do this? Of course not! Why not? Because the doctors want to feed the patients a bunch of bull and have the patient swallow it without question--hook, line and sinker.<br><br><br><br>
In my opinion, doctors are some of the most atrocious liars, deceivers, misleaders, double-talkers and weasel-worders on the planet. They make used-car salesmen look like saints.
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by FemmeDemonica</i><br><br><b>I would NEVER recommend DNR in place of a durable power of attorney or living will. I'm wondering now, though, does that durable POA override that patient's DNR? I have no clue. I'll have to ask around here...</b></div>
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It is my understanding--although I could be wrong--that it is just the opposite, i.e., the patient's DNR overrides (in effect) the durable POA. This is because that patient is giving (through the DNR) an advance directive as to what to do if resuscitation is otherwise called for. So you don't need to ask the "substitute decision maker" under the durable POA, because the patient himself/herself has already spoken on this issue. The durable POA only really comes into effect under conditions where the patient cannot decide and has given no specific advance directive as to what to do.
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by Joe</i><br><br><b>I partly agree, but mainly disagree with the implications of this.<br><br><br><br>
Of course, patients are adults and have the right to make their own decisions.<br><br><br><br>
But a real "choice" implies "informed consent," and I believe that patients are not really giving "informed consent" because they are basically being lied to or misinformed or underinformed by doctors and other so-called "medical professionals."</b></div>
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I haven't explored the extent to how medical professionals misinform people over living wills, but I do agree that informed consent could be questioned in many ways, bc a lot of people may not really realize the pros and cons of different kinds of advance directives they create (like my drowning example).<br><br><br><br>
There are so many situations one many never anticipate, perhaps like with Joe's mother (I am very sorry to hear that that happend.), so when I make my living will (soon, I hope) I will make it very flexible, and mainly state my general feelings, and who and how I would like decisions to be made. I will ask someone whom I trust to make decisions wisely, and according to my values, not just specific rules. Very strict living wills can lead to very bad situations that no one could've forseen.<br><br><br><br>
A decision making proxy shouldn't be able to override a DNR, but they may be able to if they make a big enough stink and talk the physicians into it, but the Dr.s could then get sued ("wrongful life"). You could also bring a legal case saying the person was incompetent at the time of creating it, but that would be very messy and difficult.
 

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Well, Ruthie, let me say this:<br><br><br><br>
I have raised two issues with you:<br><br><br><br>
1. That DNRs <b>in fact</b> affect the quality of care that a patient receives from the moment they are agreed to, even though they are <b>not supposed to</b> do this; and<br><br><br><br>
2. That doctors and hospitals and other "medical professionals" have a selfish or self-serving motivation to seek DNRs from patients, in terms of helping to avoid or helping in the defense against malpractice suits, helping in avoiding or defending internal reviews regarding the deaths of patients, etc., and that the nature of the "information" they provide to patients to secure "consent" to these DNRs is biased by these selfish motives.<br><br><br><br>
Now, what I'd really recommend that you do is consider both these issues as something you need to research. There must be some studies done on these issues, some literature on the subject, and you should be able to find this information on the internet and/or at your local library. Do your own research, familiarize yourself with the literature, and draw your own conclusions about what is best to do in the light of the best information you can find.
 

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Here is one link, I will try to find more<br><br><a href="http://www.clevelandclinic.org/bioethics/policies/dnr.html" target="_blank">http://www.clevelandclinic.org/bioet...icies/dnr.html</a><br><br><br><br>
If you are concerned about quality of care, your loved one may instead of the DNR, assign durable power of attorney to someone they trust to give the DNR go ahead when they feel it is appropriate. This would most likely be given right at the time the decision needs to be made, so they physicians would not know before the time came if it would be given.<br><br><br><br>
Sadly, I think that Joe may be right about this quality of care issue. I will ask my bioethics professors about this.
 

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<div class="quote-container"><span>Quote:</span>
<div class="quote-block"><i>Originally posted by Thalia</i><br><br><b>Here is one link, I will try to find more<br><br><a href="http://www.clevelandclinic.org/bioethics/policies/dnr.html" target="_blank">http://www.clevelandclinic.org/bioet...icies/dnr.html</a><br><br><br><br>
If you are concerned about quality of care, your loved one may instead of the DNR, assign durable power of attorney to someone they trust to give the DNR go ahead when they feel it is appropriate. This would most likely be given right at the time the decision needs to be made, so they physicians would not know before the time came if it would be given.<br><br><br><br>
For example, when my grandpa had a heart attack, they called my mother, his guardian and power of attorney, and asked how aggressively to treat him.<br><br><br><br>
Sadly, I think that Joe may be right about this quality of care issue. I will ask my bioethics professors about this.</b></div>
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Wow! These are all things I have never considered. Thank you all for sharing your views and experiences. A difficult decision no matter how you look at it...
 

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Discussion Starter · #20 ·
Thanks for the link Thalia. I didn't know that there were different DNR types. This is so helpful. I'm going to speak with my mom tonight about this. I've printed a copy for her and my sister. I'm going to try and get my sister over there tonight with me so that we can discuss it together.<br><br><br><br>
I'm taking Joe's advice too and pulling together as much information as I can so that she can make the most informed choice.<br><br><br><br>
Lately I find myself not wanting to be an adult anymore. I want to leave my job, home, car, everything and go live on the streets with the homeless people. Suddenly I've realized that those things just don't mean much anymore..in the big picture of life they don't really have any meaning. I don't want anymore adult responsibilities. Whenever I would feel down Mom would make me a bowl of tomato soup and a grilled cheese sandwich (my favorite meal as a kind). It's funny now how this has made me think back to how the smallest things she would do used to make me happy. I'm feeling so helpless now because I don't know what to do to make this better. That's the hardest part. The feeling of helplessness. I know this has nothing to do with the topic, I just felt the need to write it out. I think I'm loosing it...
 
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