Good article.
Surprisingly very little is taught on DNR from both sides. When you go to a lawyer for your living will, the DNR is explained legally, not what it actually means to you.
Yes, this means if you are in a car wreck and you are identified, somehow, as DNR (Like you say it for some reason) you will be the last one out.
I have orders for preservation and care. My wife does not. I have to be around for her orders to be carried out. She doesn’t have a tattoo, it’s not on an medical paperwork, it’s not a bracelet. Now some people have those things, some do not.
For EMR (Electronic Medical Record) the staff and doctors know that EMR is so far off that it can’t be trusted with such life-and-death decisions. Basically, “DNR” is just a checkbox that some sloppy nurse can hit. It means nothing. They operate like it’s not there.
That’s kind of the point of DNRs. The act of resuscitating is very destructive and depending on how long you’re down there can be a lot of permanent damage. I know a doctor who has his DNR tattooed over his heart, he has resuscitated people, he’s helped people recover from it, he’s made a decision.
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Daughters of the Nigerian Revolution?
I have been told that signing for donating your organs narrows down your survival rate.
And don't get me started about the lizard people and their hunger for raw innards.
later
I won’t sign a DNR or an organ donor card.
“Fewer MRIs and CT scans, fewer medications, even fewer bedside visits from doctors. “
Fewer bills
I think DNR election had a direct bearing on the timing of my Mother’s death in the nursing home. They barely communicated to me and I think they knew her condition was much worse than they were letting on to me. They called me at two AM telling me that they thought she was in her “last stages”. It took me ten minutes to get there and she was already gone when I arrived. I really think she was dead when they called me. I was very upset the way it happened, but there was really nothing I could do or say.
So true. Also, if they ask you if you have an end-of-life doula, it helps make those cruel health insurers pay more!
http://inelda.org/
This is shoddy journalism. And it is not cause and effect.
People who have signed DNRs are more likely to be a lot less healthy going into a hip fracture.
This is a POS article slamming the medical field. DNR patients get antibiotics and many other kinds of healthcare.
Seriously shoddy crap.
CPR for all other conditions causing death in a hospital (cancer, AIDS, GI bleeding, etc) has very poor results and should not be the norm. I mean, think about it.
If your heart stops because cancer has invaded your chest and choked off blood return, or because treatment for your AIDS pneumonia has failed, or because you've bled out despite two big IV lines and 8 units of blood on pumps, CPR is a bizarre and unpleasant ritual with no possibility of success.
In almost all cases, this decision is easy for a patient's real doctor, if he/she has one.
My only choice, if they force me to go to ground temperature, is for my family to call Willow, Xanda, Anya, and Tara...They'll know how to get me back...
A DNR is usually discussed when the patients health problems mount to the point that where continuing treatment will just basically prolong the suffering.
In Texas at least, any person on scene can revoke the DNR, even against the patient’s wishes, by just saying “work them.”
In 30 yrs, I have never encountered a DNR that didn’t appear to be based on an informed decision.
I don’t know the person that wrote this article but I have worked at a hospital for nearly 38 years and to say that “you are routinely encouraged to sign a DNR” is probably one big, fat LIE.
People that have dedicated their life to healthcare do NOT routinely encourage people to kill themselves. I know better than this.
Are DNRs discussed, yes, we’re required to by our ever intrusive overlords (there are many different kinds of them - not just the federal gov’t). Are people “routinely encouraged to sign a DNR” ...... bullshit.
Additionally, if someone wants to simply be made comfortable we initiate comfort measure only orders. That is when we withhold antibiotics, medication etc because death is coming. Often this is for cancer patients or other end of life patients. More often than not we won’t initiate dialysis and this is often what allows a natural and pleasant end of life supplemented with appropriate pain control.
The comment on the hip fracture is pure BS. If you have surgery ALL DNR orders are suspended becuase what I do as an anesthesiologist is essentially a resuscitation and life support. If you consent to surgery you consent to full life saving measures as a condition of surgery. DNR only is reinstituted once the perioperative period and recovery ends.
No ethical physician would not care for a DNR patient and give the absolute best. As for me as an intensivist my loved ones know (my sister who is a physician) knows that I do not want my death artificially prolonged in painful and awful ways including long term ventilation so I can get bed sores and multiple rounds or infection. I know heaven awaits me
What patients SHOJLD worry about however is the pressure that non-clinical administrators who run hospitals put o. Physicians to reduce length of stay. I have had administrators in my career suggest I should have a comfort care only discussion based on length of stay. This particular administrator was the Chief Financial Officer of a large for profit hospital chain. Needless to say the answer he received was not what he expected of the chief medical officer of the same hospital which I was at the time.
Sadly most hospital based physicians are becoming employees of large groups and evaluated based on metrics that have to do with things like length of stay, reduction of cost, and require double checks from administrators on testing and lab. Please do not hesitate to look up such companies as Envision, Teamhealth, Intensive Care Consortiim and their websites. If you look far enough you will find the main thrust is reducing costs not patient care. Caveat Emptor sadly now applies to healthcare.
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.
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.