Last Wishes I

[Mdlerth]

Let me go when the bill hits $5k

I also carry a copy of my directive in my wallet. It's folded so that it's easy to find. (I realize it is highly unlikely an EMT won't make every effort to save me after an accident. But I feel better having it accessible in an emergency.

Is there a DNR equivalent to those life alert bracelets which communicate conditions of concern to first responders? That way if they find you've coded they wouldn't have to look far to locate your intentions.

 

[Teacher Terry]

Yes I read the book because it was recommended on another thread. We also have all our documents in order. Here if you die and have seen a doctor in the past year, the death is not suspicious and no autopsy is done. My husband was concerned that my kids might think he killed me. My kids love him and I think it’s a unnecessary worry but better safe than sorry. I am really sorry about your wife Scraper.

 

[Telly]

Is there a DNR equivalent to those life alert bracelets which communicate conditions of concern to first responders? That way if they find you've coded they wouldn't have to look far to locate your intentions.

A few years ago, I talked with our then-Fire Rescue Chief about the use of a DNR for first responders. I had talked with him for years before the start of city meetings, so he knew me, and I had helped him/me/us in convincing city elected officials on the need to finance and acquire some new expensive equipment, so there was no reason for him not to be truthful with me.

Findings... A DNR is useless to first responders. They will neither look for it nor use it if one was presented. He said all Fire Rescue departments around here are the same. Their task is to treat and transport the patient/victim to the appropriate next level of care ASAP. Then their job is done. There is no holding back on any available treatment. They need to be able to show that they did everything within their power and resources at the time. This was a surprise to me.

He also mentioned that our state does have a program where one can wear a bracelet, necklace whatever, but said that is for a different situation. He gave me the name then and said it was on one of the state's websites. I looked it up then, it requires registration, tough hoops to jump through, you have to have at least two physicians certify that you are in the last 6 months of a terminal illness.
Our F-R Chief said it was created for out of hospital transport of hospice or hospice-like patients. So it was of no use to me, what I was looking for now.

You may want to find out via F-R in your area what their approach is to DNRs. A VFD Chief told me that lawsuit avoidance is paramount for them, do everything by the "keep'em alive no matter what" rule, till the patient/victim is handed off, then not their problem anymore.
I don't like it, but I understand it. But no solution presents itself to me, other than what I mentioned posts above in this thread, and that is only with someone and someplace that it occurs that it could work out.


EDIT - Teacher Terry, thank you for posting this topic. It is one I wanted to broach for years here, but didn't know how I could phrase it. Now that you broke the ice, it's easier. Thanks Again!

 

[Scrapr]

A few years ago, I talked with our then-Fire Rescue Chief about the use of a DNR for first responders. I had talked with him for years before the start of city meetings, so he knew me, and I had helped him/me/us in convincing city elected officials on the need to finance and acquire some new expensive equipment, so there was no reason for him not to be truthful with me.

Findings... A DNR is useless to first responders. They will neither look for it nor use it if one was presented. He said all Fire Rescue departments around here are the same. Their task is to treat and transport the patient/victim to the appropriate next level of care ASAP. Then their job is done. There is no holding back on any available treatment. They need to be able to show that they did everything within their power and resources at the time. This was a surprise to me.

He also mentioned that our state does have a program where one can wear a bracelet, necklace whatever, but said that is for a different situation. He gave me the name then and said it was on one of the state's websites. I looked it up then, it requires registration, tough hoops to jump through, you have to have at least two physicians certify that you are in the last 6 months of a terminal illness.
Our F-R Chief said it was created for out of hospital transport of hospice or hospice-like patients. So it was of no use to me, what I was looking for now.

You may want to find out via F-R in your area what their approach is to DNRs. A VFD Chief told me that lawsuit avoidance is paramount for them, do everything by the "keep'em alive no matter what" rule, till the patient/victim is handed off, then not their problem anymore.
I don't like it, but I understand it. But no solution presents itself to me, other than what I mentioned posts above in this thread, and that is only with someone and someplace that it occurs that it could work out.


EDIT - Teacher Terry, thank you for posting this topic. It is one I wanted to broach for years here, but didn't know how I could phrase it. Now that you broke the ice, it's easier. Thanks Again!

I have had some experience with Hospice the last 2 years. 4 cases. Once you are admitted to hospice you are out of the regular medical care chart. There is no curative methods applied. Mrs Scrapr wanted to try one last dose of Keytruda (immunotherapy) but also be on hospice. She could do either/or, not both. Hospice is Medicare program. So the Feds are paying for it. Wouldn't make sense to put a really expensive treatment onto the Feds with small hope of cure

Once on hospice you don't call 911. You are instructed to call hospice directly. So absent an accident or something first responders would likely not come to a hospice patient home. The gray area is if the patient is on that fine line between pallative care & hospice care. Pallative care would call 911. In our area the POLST notice is supposed to be on the fridge. It is registered in a database and first responders are supposed to check. That registration may be a bit slow as Mrs scrapr got her registration number 2 weeks after she passed. A POLSt is not a DNR. But pretty close

POLST info:

https://polst.org/

 

[ExFlyBoy5]

I would be hesitant about recording last wishes via camera/audio as some jurisdictions may very well ignore this as there is no way to tell if it was recorded under duress. Anyone who went to a military survival school will tell you that it's very easy to manipulate a video recording..to a degree that would surprise almost anyone. Best thing is familiarize yourself with the law in your area and it's not a bad idea to contact an attorney for guidance.

Thanks for the reminder, Teacher Terry. Like Telly, I am concerned about those who for their own reasons would ignore my DNR. I have been giving some thought to how I can have a lawyer on retainer, with a sufficient amount of money set aside for litigation costs, to sue the crap out of them for making me suffer. But I'm not certain that my estate would have legal standing.

As you very well know, once you get the court involved, things could get very, VERY slow. Look at Terry Shiavo as a good example.

As far as a DNR, this is also very dependent on the jurisdiction. In my Dad's case, once it was created (as part of hospice) we had copies of it in his wallet, in his medical record and displayed on the main door to the house (in the garage) and the fridge. Some healthcare providers will NOT give you a DNR unless you have a terminal condition...and note that a DNR is NOT the same as an advanced directive.

Findings... A DNR is useless to first responders. They will neither look for it nor use it if one was presented. He said all Fire Rescue departments around here are the same. Their task is to treat and transport the patient/victim to the appropriate next level of care ASAP. Then their job is done. There is no holding back on any available treatment. They need to be able to show that they did everything within their power and resources at the time. This was a surprise to me.

He also mentioned that our state does have a program where one can wear a bracelet, necklace whatever, but said that is for a different situation. He gave me the name then and said it was on one of the state's websites. I looked it up then, it requires registration, tough hoops to jump through, you have to have at least two physicians certify that you are in the last 6 months of a terminal illness.
Our F-R Chief said it was created for out of hospital transport of hospice or hospice-like patients. So it was of no use to me, what I was looking for now.

You may want to find out via F-R in your area what their approach is to DNRs. A VFD Chief told me that lawsuit avoidance is paramount for them, do everything by the "keep'em alive no matter what" rule, till the patient/victim is handed off, then not their problem anymore.
I don't like it, but I understand it. But no solution presents itself to me, other than what I mentioned posts above in this thread, and that is only with someone and someplace that it occurs that it could work out.

All good info and illustrates that everyone really needs to see what the law says SPECIFICALLY where they live as it can be very, VERY different.

 

[ncbill]

The best document is a health care POA (not a living will or even DNR) for those in the U.S.

In it you not only specify your wishes but also appoint a health care agent who has the legal authority to make health care decisions for you when you cannot.

Personally, I would give as broad powers as possible to your health care agent...presumably you've discussed your wishes extensively with them, so you shouldn't tie their hands.

Sometimes, the agent should not be your spouse (e.g. Casey Kasem's sad death)

It is important to use the health care POA forms that are recognized by your individual state, since in at least one U.S. state two forms are required:

one for 'everyday' health care decisions, and another that authorizes the health care agent to add/remove 'life-sustaining' care (ventilator, feeding tube, etc.)

 

[Teacher Terry]

Bill, we had a lawyer draw up all the necessary paperwork years ago. Here if you carry the DNR around with you paramedics will respect it. Of course people are usually terminal.

 

[ivinsfan]

There certainly is. A few other States as well. I may have shared this previously. Mrs Scrapr fought her cancer for nearly 2 years. Near the end we talked about the Death with Dignity (DwD) option. One of her tumors was pressing on her windpipe. Making it hard for her to breathe off & on. We got on the DwD program and she was able to decide when & where to use it.She was worn out physically. The last few days would have been excruciating for her & myself. To no good effect. I highly recco the DwD option. One month ago.

So sorry about your loss, it's very good of you to be posting on a thread like this so soon after your DW's passing. It can't be easy for you to re-visit those last days but your comments take on a special meaning.

 

[HI Bill]

I'm not sure how legal it is in many states, but completing 5 Wishes is a good place to start. But a better place to start is with family. Complete a medical POA. Sign a DNR. Let them know uniquivocably whether you want to be intubated or have CPR. Make them know that regardless of how hard it is, when it's time to let them go, let them go.

Doctors, hospitals, long term care facilities - they all want to treat and prolong life, regardless of the quality of life. When my mom was dying in a long term care memory unit, the facility said "she had a few good years left", and the hospital doctor said "I've treated her arrhythmia." But she was sleeping most of the day, barely eating, had fallen and broken her pelvis, and was incontinent and needed help feeding, cleaning, dressing, and....well, everything. Her memory was mostly gone. The long term care facility applied for the insurance company to give her appetite-enhancing drugs...the approval came too late. Hospice care was the answer. No more visits to the hospital, no more unnecessary blood draws in too-thin arms, no more drugs except for pain control.

 

[street]

I am just starting, but even the introduction was profound. The author is a well renowned surgeon with other best sellers previously penned.

Upon completion, I'll update this thread.

Just got the book and so far very interesting and informative but still a good narrative story.
Thanks

 

[Calico]

There certainly is. A few other States as well. I may have shared this previously. Mrs Scrapr fought her cancer for nearly 2 years. Near the end we talked about the Death with Dignity (DwD) option. One of her tumors was pressing on her windpipe. Making it hard for her to breathe off & on. We got on the DwD program and she was able to decide when & where to use it.She was worn out physically. The last few days would have been excruciating for her & myself. To no good effect. I highly recco the DwD option. One month ago.

I am so very sorry to hear that Mrs Scrapr lost her battle. I am glad that she was able to choose the DwD option when she felt the time was right. My condolences to you and all of Mrs Scrapr's loved ones.

 

[Midpack]

I hope to go on my own terms, but I can see how it’s hard for doctors to honor a patients DNR, it’s counter to their central purpose.

And in today’s litigious world, I am sure attorneys advise doctors, hospitals, EMT’s, etc. to keep patients alive no matter what even if you have a DNR. Once you’re gone, they have no way of knowing what your family might do on your behalf, they might slap a lawsuit on a doctor who didn’t do everything possible. The hospital can spend $ defending themselves for honoring your wishes OR charge you $ for end of life care - a really simple business decision.

And it’s cynical, but end of life care is often very expensive and profitable, so the hospitals business people may want to see those procedures charged when possible.

We went through this with my Dad whose death was prolonged for months against his wishes. He lost about 40 pounds under “doctors care” before his life ended. It was only because of his well documented wishes, his active refusal to accept treatments, an advocate (my sister), and hospice care that they finally let him go - after almost three months. Taxpayers (you) paid for all that very expensive treatment through Medicare & TriCare even though he didn’t want it, despite our daily efforts to stop it...

 

[ncbill]

A great example of why a DNR, by itself, is not very useful.

With a health care POA, the health care agent has the legal authority to act per the terms of the POA once the patient cannot make their own decisions.

Again, hopefully the POA has been written as broadly as possible to allow the agent to refuse life-sustaining care, even if the hospital/doctor wants to continue aggressive treatment.

Of course, the agent has to be able to stand up against a system that simply wants to continue treatment, as I'm sure many of us have experienced.

I've had loved ones with a DNR transported to hospital, even though that shouldn't have happened.

Though, with their health care POA already on file, the hospital called me for instructions & I told them just to keep them comfortable, which the hospital did until they died a few hours later.

 

[Bestwifeever]

.... Mrs Scrapr fought her cancer for nearly 2 years. ....One month ago.

I’m so sorry to read this; you fought too. Hugs.

 

[Teacher Terry]

If you are on hospice they display your DNR on various walls in your house and also carry it with you at all times. No one from hospice will call a ambulance.

 

[bmcgonig]

A great example of why a DNR, by itself, is not very useful.

With a health care POA, the health care agent has the legal authority to act per the terms of the POA once the patient cannot make their own decisions.

Again, hopefully the POA has been written as broadly as possible to allow the agent to refuse life-sustaining care, even if the hospital/doctor wants to continue aggressive treatment.

Of course, the agent has to be able to stand up against a system that simply wants to continue treatment, as I'm sure many of us have experienced.

I've had loved ones with a DNR transported to hospital, even though that shouldn't have happened.

Though, with their health care POA already on file, the hospital called me for instructions & I told them just to keep them comfortable, which the hospital did until they died a few hours later.

I guess I'm wondering who calls the ambulance that transports them to the hospital? And why did they call?

 

[jIMOh]

We are not living longer
we are dying slower

I have heard more than one insurance salesman use that line and I repeat it often in conversation, most people tend to agree.

 

[Teacher Terry]

Bmc, maybe a family member panics and calls.

 

[Breedlove]

Don't we die a little every day

 

[ivinsfan]

Don't we die a little every day

somedays more then others.....

 

[Nemo2]

Don't we die a little every day

Some days are more meteoric than others.

 

[GravitySucks]

Sorry to hear of your loss Scrapr.
A couple of notes:
I was DWs health proxy and she had a DNR. When the hospital called at 3 am asking permission to do a procedure they make it sound like no big deal. I didn't say no and I don't think she ever forgave me for not just letting her die then. It matters greatly on who you pick as your proxy.
DM was in a car accident last year and filled a DNR out in the ER. She was then transfered to a trauma center at another hospital. That hospital did not recognise the DNR from hospital 1 and said she wasn't capable of filling one out at that time.

 

[ncbill]

I guess I'm wondering who calls the ambulance that transports them to the hospital? And why did they call?

Middle of the night, the resident seizing (not on Hospice, they developed an infection that turned septic)

Here in institutions they don't allow posting DNR above the bed anymore...since it's part of their medical file apparently that's considered a HIPAA violation (crazy, huh?)

Night staff at most places (assisted living or nursing homes) are minimally-trained CNAs, not surprising they'd panic and call an ambulance for a resident exhibiting the above behavior, can't exactly blame them.

Again, another reason you want to have a health care POA, not just a DNR order.

 

[gwraigty]

If you are on hospice they display your DNR on various walls in your house and also carry it with you at all times. No one from hospice will call a ambulance.

A neighbor of mine wound up in an unfortunate situation when her husband died at home while on hospice. She panicked, ran out into the street, a neighbor called 911, EMTs kept trying to bring him back despite being told by the neighbor who called 911 that he had a DNR. For reasons I don't understand, there was no DNR paperwork in the house. Someone called hospice and a nurse came with the DNR. Until the EMTs were presented with the paperwork, they wouldn't stop working on him, despite the futility of it all. The whole thing caused my neighbor more stress than necessary.

 

[ncbill]

Last death of a relative (earlier this year) went much better.

I had moved them from a nursing home to an assisted living facility near me.

Had to switch Hospice providers but that went fine.

One night around midnight the assisted living facility called to tell me they had died, would I come over?

I told them to call the funeral home (literally a few blocks down the road) & called Hospice to make sure they were notified, then I went back to sleep.

Went by the facility in the morning to retrieve their personal effects, then by the funeral home that afternoon to meet with their out-of-town kid who did the required identification.