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Old 03-04-2013, 07:43 AM   #21
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My mom, who died last year, was always very careful to make sure her caregivers all understood that she had a DNR order in effect and was very serious about it. I was grateful that they honored her wish.

OTOH, my dad, who died in 1996, also had a DNR order but it was ignored. That cost him an extra few months of painful, uncomfortable existence, and it was torture for him and me.
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Old 03-04-2013, 07:51 AM   #22
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OTOH, my dad, who died in 1996, also had a DNR order but it was ignored. That cost him an extra few months of painful, uncomfortable existence, and it was torture for him and me.
That is why we (my sisters and I) honored Mom's DNR. We are comfortable with the decision and saw no point in prolonging the inevitable given her condition.

FIL has a DNR in effect also and we will honor it too. The guy has been in nursing care/hospitals since last November. I can't imagine that anyone would want to go on existing like that.
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Old 03-04-2013, 08:03 AM   #23
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Obviously, the whole story became newsworthy when the 911 call was made and the dispatcher's request for CPR was ignored. I still don't know whether or not the 87 year old woman had a DNR on file (different reports about that). And, the daughter was happy with the care the facility had provided. Like, everyone knew about the policy of that facility. If you assume there was a DNR on file, and the policy of the facility was to not perform CPR, why even make the 911 call? Just a lot of questions in my mind. I need to hear more of this case before I could draw any conclusions.
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Old 03-04-2013, 08:04 AM   #24
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That is why we (my sisters and I) honored Mom's DNR. We are comfortable with the decision and saw no point in prolonging the inevitable given her condition.

FIL has a DNR in effect also and we will honor it too. The guy has been in nursing care/hospitals since last November. I can't imagine that anyone would want to go on existing like that.
My parents have DNRs (legal documents), and they are adamant about it, have told my sister and I in person several times. We will honor their clear requests if necessary (probably low odds).
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Old 03-04-2013, 08:59 AM   #25
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I recently completed a CPR certification course. We practiced performing CPR on specially-equipped dummies that light up to show you whether the compressions are done correctly (hard enough). Most of us were pretty surprised at how hard we had to work (using both hands) to get it right. We were told that 80% of adults will suffer from broken ribs if the CPR is performed correctly.
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Old 03-04-2013, 09:26 AM   #26
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And just a quick plug not to forget the Heath Care Power of Attorney for your state of residence, which can have far more impact on your care and can be used to help guide your caregivers to the right decisions if you are not able to make them. The HCPOA is important to have, and you should have an alternate named in case your primary is not able to perform. I have chosen my DH as primary and a good friend who is a no-nonsense oncology RN with lots of experience as my alternate.
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Old 03-04-2013, 10:53 AM   #27
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You would think CBS and CNN would have their facts straight before reporting anything, clearly at least one does not (and I'm naive). Who knows...
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Old 03-04-2013, 10:56 AM   #28
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If there had been clear communication from the get-go, this would never have been an issue.
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Old 03-04-2013, 11:26 AM   #29
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If there had been clear communication from the get-go, this would never have been an issue.
Do we know yet? FWIW "17 News contacted the family of Lorraine Bayless. Her daughter said she has no problem with the care her mother received at Glenwood Gardens."
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Old 03-04-2013, 01:57 PM   #30
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Oregon has a document called a POLST (Physician Orders for Life-Sustaining Treatment) which the physician and the patient sign when the patient is seriously ill/at the end of life. When 911 is called and EMT's dispatched this document is on their computers, hospital computers and a copy should be filed with nursing home/care givers. This is above and beyond a health care directive, it is in force even if the persons with the power of attorney for health care are unavailable and it cannot be usurped by others.

The document was the result of an elderly lady who did not want resuscitation being put in intensive care when the persons who could invoke the health care directive were out of the country. The woman's heirs funded the development of the POLST.
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Old 03-04-2013, 04:28 PM   #31
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If she had a DNR on file with the facility that would be one thing, but if she doesn't it seems as if the facility has a moral obligation to try to save her life by administering CPR. I'll bet the facility policy is based on liability issues. Seems stupid though.
IMO the moral obligation is to not perform CPR on someone in their 80s.
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Old 03-04-2013, 05:13 PM   #32
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At the other end of the DNR process - passing over: I believe that there needs to be a "birthing to the other side" procedure. Our culture is sorely lacking in some instances (nursing homes) in easing e.g. panic on the part of the patient as he/she goes. At least, I think it is a conversation that would be welcome by many patients and families.

When Mom (at 89 years old) was in the hospital at the end of her life (she had COPD, and had trouble breathing) I made sure that the nurses followed her doctors orders. She was to be given a shot of morphine every few hours so she would not panic at not being able to catch her breath. Thus, her passing was relatively 'stress-free' for all of us.

If I were in the process of dying, I would certainly appreciate a smoother ride than having to white-knuckle dying.

If there is a DNR order, it seems to me that nursing homes can at least give the patients a shot of appropriate medication to ease the transition.
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Old 03-04-2013, 05:46 PM   #33
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Old 03-05-2013, 01:09 AM   #34
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I may have missed something, but why assuming that there may have been no clear communication from the get-go? The only question IMO is : were protocols and policies followed ?
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If there had been clear communication from the get-go, this would never have been an issue.
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Old 03-05-2013, 06:19 AM   #35
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Good point. Had the RN not followed protocols, had performed CPR and had broken one of the patient's ribs, she could have been sued because she did not follow protocols. At the very least, she could have been reported to her Board and some people could have claimed she abused the patient. Sad.

Interestingly, USA Today this morning says that it seems that all residents have been informed of the non-CPR policy and have agreed to it when they moved in.


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I recently completed a CPR certification course. We practiced performing CPR on specially-equipped dummies that light up to show you whether the compressions are done correctly (hard enough). Most of us were pretty surprised at how hard we had to work (using both hands) to get it right. We were told that 80% of adults will suffer from broken ribs if the CPR is performed correctly.
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Old 03-05-2013, 08:45 AM   #36
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If there had been clear communication from the get-go, this would never have been an issue.
Sounds to me like the media has the miscommunication issue. Big surprise that! (NOT!)
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Old 03-05-2013, 09:05 AM   #37
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I may have missed something, but why assuming that there may have been no clear communication from the get-go? The only question IMO is : were protocols and policies followed ?
It appears that the patient and her family had communicated their wishes with the staff of the home. But why did the nurse dial 911 if the resident had a DNR? Did she not know, or was it CYA? And having made the call, why did the nurse not make it clear to the dispatcher that the patient had a DNR? Why did the dispatcher not ask? Clearly they had different mental models of the situation and were not communicating. Finally, who took it upon him/herself to share this with the media, under the misapprehension that CPR was the right thing to do? Too much communication again.

The best that could come out of this is improved public and professional awareness of the importance of documenting ones wishes and understanding what that means you won't do when there is a DNR.
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Old 03-05-2013, 09:26 AM   #38
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IMO the moral obligation is to not perform CPR on someone in their 80s.


Some people in their 80s are very happy to be alive.

My mother nearly died of a cardiac problem around that age, but was saved by surgery and is now leading a happy life, taking care of her granddaughters very often, etc. And I'm very glad she's still around.

I'll be turning 45 soon and can't imagine that I would ever want a DNR order, UNLESS my quality of life would become particularly bad. You can't deduce from someone's age that that person doesn't want to be alive as much as you anymore.

In much of the developed world people are living longer than in the past and staying healthy longer. And with medical progress that will hopefully improve even more in the future. I certainly hope people taking care of me in my old age won't assume I'm cool with dying and will do everything they can to keep me alive until I decide I myself that I want to die.
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Old 03-05-2013, 09:32 AM   #39
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The incident has fired up a lot of discussion about death issues. As I speak, the Diane Rehm show is discussing a proposed Montana law that would put docs in jail for 10 years for helping old folks off themselves. I saw some talking heads yesterday who breached the subject of excessive spending in the last days of old folks lives. I hope the talk leads to more improvments (as I see them) like the compassion in death laws in Oregon and Vermont.

If the 911 agent had succeeded in intimidating the aide into letting a visitor give CPR the probable outcome if the CPR worked would be that the old lady would have burned up $250K or so lingering a few months longer in a hospital with broken ribs and a broken spirit. For the religious among us who always call for hands off, it strikes me that CPR in such a case is an attempt to stay God's hand.
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Old 03-05-2013, 09:37 AM   #40
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For the religious among us who always call for hands off, it strikes me that CPR in such a case is an attempt to stay God's hand.
I agree it is a difficult question - but to your quoted point, couldn't you say the same thing with regard to vaccines, antibiotics, or chemotherapy? Where do you draw the line?
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