Posted on 03/28/2018 2:41:40 PM PDT by Twotone
I must have misunderstood you.
The article outlines how medical sort of abandons patients who want DNR for specific things, and allows them to die even when it is against their wishes.
There is no need for a DNR if you have a Durable Power of Attorney for someone you trust implicitly - and with prior conversations outlining your wishes; someone who because of that durable power of attorney has the authority to make medical decisions for you if you are incapacitated in any way that prevents you from making them.
If you have any kind of DNR instructions - and what are to you the only acceptable contexts for them, you discuss them with whom you give your durable power of attorney. Those instructions then remain between you and the person you assign to act in your stead.
When I needed such things (which I did once), I was fortunate to have a very close family member, a doctor who is the wife of a nephew, and to her I assigned my durable power of attorney. Fortunately it was not needed at the time, but I went into spinal surgery feeling better that someone I trusted implicitly knew what my concerns and wishes were. No “DNR” just a durable power of attorney. In fact, I held up my emergency surgery, in spite of the hospital and surgeons pleading, until we got the durable power of attorney signed. It WAS a mental relief in that critical time.
For all of you: don’t wait for an emergency; have your durable power of attorney set up ahead of time, just as you should your will.
From the article:
DNRs are dangerous for patients with pneumonia, trauma, strokes, vascular problems and other treatable conditions, according to studies in the Archives of Internal Medicine and Critical Care Medicine. An analysis of California hospitals published in the Journal of the American College of Cardiology found that patients had higher death rates in hospitals that encourage DNRs. Amazingly, these hospitals worried that their higher death rates lowered their Medicare quality rankings and reimbursements. They wanted the ranking method changed.
I agree with you on some points. Of course I have see. A patient who is in rigor. I didn’t initiate CPR. I have handled major traumas and pumpers. I have placed large lines and rapid infusers work sometimes. Sometimes they don’t. A blown aortic aneurysm game over unless there is a surgeon. What I think you are getting at is that a physician can say I am not going to start CPR becuase there is no benefit. I am comfortable with this decision. In other words most law says that I cannot be compelled to proceed in a futile condition. Not sure that is entirely a proliferation legislation but I would prefer that in the absence of a physician with years of clinical expertise and acumen that nonphysician providers be required to follow protocols. And yes I have extensive experience in ACLS in the field and all hospital settings. Your points are well taken
And you now see it’s all about the money. I have personally al knowledge of certain practices where numbers are manipulated to remove mortality. The games that are played in the name of metric management are horrifying. I agree with the poster who said have a durable POs who knows your wishes and will advocate for you
While I agree with part of what you said trust me all hospitals are alike. They have to manage the same metrics and I have seen not for profit and for profit alike put the management of length of stay ahead of the patient. The only way to reverse this I fear is for we physicians to grow a spine and take back our profession. In my opinion nonclinical hospital administrators are the spawn of Satan. Oh sure they talk a good game but just below the surface it is ALL about the metrics. I happen to be of the opinion and have said this in numerous national lectures that when we take good care of the patient everything else falls in line. But too many people can make a living or name for themselves by managing a metric instead of caring for a patient.
I have one with very specific instructions
Had a doc berate me for it. I reported him. I know what I want and what I don’t. I’m content with my decision
I received excellent care when in hospital and rehab.
There are certain things I will not agree to just because a doc wants them. As a patient that is my right. My obligation is to let them know.
I’ve signed a donor organ card.
A DNR makes sense when you’re terminally ill and heroic measures to save your life won’t add to the quality of your life - you can tell your doctor you want to die with dignity.
I watched my dad suffer in the last few weeks of his life in a coma dying and I wouldn’t wish that on any one. It affected me in ways I still don’t understand years later.
A DNR can take the burden off family and friends about your intentions if you’re dying by letting them know what you want and giving them peace of mind.
Its not for all circumstances. But in some situations a signed DNR can be the right thing to do.
I don’t necessarily disagree with your premise. A patient should have autonomy. However when I get a crazy statement such as you can to CPR but no meds. Or meds and no CPR. It my personal favorite CPr but no breathing tube then it is incumbent on me to educate the patient as to why it’s a package deal. I think we all have autonomous authority. However if I am requested to do something that makes no sense or risks outweigh the benefits then my professional autonomy allows me to say no.
I am one who had a DNR when a fall at work fractured my hip. Had my paperwork faxed to doc and hospital. I got great care. In rehab their doc who is younger than I berated me for my choice. I reported him.
I am fully informed and in my right mind. I don’t want docs poking and prodding and demanding more tests that are invasive. If my heart goes so be it. Throw a party. See you on the other side. Leave me in peace
I tell patients (I told one today), “I’m not a technological waiter”.
Resuscitation of a hopelessly ill, terminal patient, often done for fear of lawsuits, often adds $300-400,000 dollars worth of futile care and the year on the tombstone does not change. Unreasonable expectations from families, Monday morning quarterback “patient advocates and most of all prowling lawyers have resulted in a system where the good judgement of the attending physician is overridden by policies made by corporate committees.
Women and minorities hurt worse.
That’s beautiful
We’ve had elderly loved ones who have had DNRs, and elderly relatives who’ve refused so far. Our refuseniks have been pressured but their wishes have been honored, we suspect because we are always there for an admission. And if there aren’t protocols for asking patients with dementia to sign a DNR, there need to be. I’ve seen some things that really disturb me when it comes to informed consent.
I mean the opposite of DNR.
I have instructions to be kept alive.
Agreed. Jeez why would you do a tube and no CPR
People need to do specific instructions. The only thing I allow is if I have an appendicitis then they can operate. Dying of gangrene is tough duty
What is more important and more understandable to most people is this question: If you act like you’re dying, what would you like us to do? If you do not want the physical trauma of CPR chest compressions (the pain of that, should you wake up, will make you wish you were dead) then sign a DNR.
If you look like you’re dying and you don’t want CPR (which will maybe restart your heart) what comfort measures do you want? Do you want your pain to be kept to a minimum? Do you want your lips kept moist?
In our state, we have the Five Wishes form. It is not a DNR, but you can have both. The Five Wishes allows you to specifically state how you want to be treated if you are actively engaged in dying. It’s a much more important document that a DNR, as it lets YOU, the patient, determine what kind of treatment you want.
I would seriously advise all reading here to look into the End of Life care paperwork your state has. And when you fill it out, fill it out with the person who is most likely to be calling the shots for you.
Simple. Don’t request a DNR and every thing will be done to keep you alive.
What you do won’t change God’s decision about when its time to call you home.
We human beings have limited power over life and death and people die every day and we don’t know why.
There’s only so much doctors can do, DNR or no DNR.
Oh, thanks. I wondered if it was something new.
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