The DNR decision?

My mom is DNR she made that decision ap any years ago .. so I respect it i will put her in hospice when the time is appropriate.. I dread that day but it's the right things to do when the time is right ,,,God Bless you I know your pain ,,know you are in my thoughts and prayers

Do not wait till the last moment to call in hospice. They can be a great source of support before they enter the final phase. Something as simple as continued weight loss or frequent hospital stays will qualify your loved one. If you don't care for their treatment it is easy to withdraw from the service there is no penalty and you can re enter at any time again with no penalty. Always worth exploring even if you don't feel ready to face end of life decisions.

Interesting points. What does happen when a heart is resuscitated. Can elderly person be resuscitated in a gentle manner without breaking the breast bone? Are there instances when an elderly person has had their heart stop and then been revived without the unacceptable pain and suffering. Medicine is progressing faster than our perceptions change. I thought all hope was lost with mother's deterioration of her Glaucoma ((eyes) due to failure of Personal Care to properly administer her eye drops). To our surprise we found out that severe Glaucoma can be treated with a non-invasive laser procedure. Had we not kept searching we would not have found this out. Mother's eye Dr. and the specialist he sent us to did not offer this treatment. We has to research on the internet. I will do this re DNR. Also, our Caregivers Support Group is meeting this week. I'll ask about this topic there. Any other thoughts on this?

I googled "gentle CPR on the elderly", and came up with nothing. CPR's main function is to get blood flow to the brain of the patient during Cardiac Arrest , and if its not started within 3-6 minutes, then the patient Will suffer brain damage from lack of Oxygen. From everything that I read and have witnessed (I personally have never had to perform CPR, but have witnessed it being done several times), CPR is brutal and normally does break ribs, especially on the elderly, but the whole intent on starting CPR is to buy time until paramedics arrive with the defibrillator, as CPR itself, rarely Re-starts the heart or saves lives on its own. Broken ribs should be the Last thing you are thinking about, if your whole intention is to resuscitate, and start the heart to pumping on its own again. Ribs heal, brain damage is forever.

Personally, I think that a Cardiac Arrest at age 100+, is Gods way of saying that their frail body has had enough, and that we should let them go naturally. We can't keep them alive forever.

I have witnessed a situation with a 53 year old patient, who had a sudden Pulmonary Embolism, and even though aggressive CPR was done immediately, and paramedics arrived within 3 minutes, the EKG, and Defibrillator pads were attached, that the Defibrillators are so advanced and Safisticated, that the monitor "Speak out loud", to "Defibrilate", or "Do Not Defibrilate", as ther are instances where Shocking will not work, or is ill advised. DEFIBRILLATION does not always work either.

Its best to have a clear cut plan of action, Before you are faced with this situation. Decisions under stress and duress, are a bad idea.

I have an ethical question about restarting the heart of an elderly person. If the person had a poor quality life should the heart be restarted? or is it Nature's way of saying enough. Even if we could get the heart beating again, should we? Say the person is more than 90 and has several serious maladies, should CPR/defib be attempted if there is no DNR order in place? If the medical proxy says not to do CPR, what could be the legal implications if the family does not support the decision?

Jessie, I think the sticking point is in who decides what a poor QOL is, and who decides what is "too old"? Not very long ago hip replacements and heart procedures would not have been attempted on anyone over 80, now that so many are living into their 90's and beyond it seems commonplace for the very elderly to be offered such treatments.

Jessie makes good points about the qualify of life. If it was poor prior to a cardiac arrest, is it going to be just as poor or worse if revival is possible? And would the condition that caused it still be a problem, or could it be corrected to avoid a repeat crash?

Then there's the rib cracking that, from what I understand will likely occur. I've never had cracked ribs but I'm guessing it would be very painful. Add that to the other existing conditions, and I think anyone with multiple comorbidities might be worse off afterwards.

I'm certainly not against CPR; I just think that at some point, keeping someone alive for a questionable if not poor quality of life isn't favorable to the patient.

I know if it were me and I had multiple co-morbidities and a poor quality of life, I wouldn't want to prolong that.

Jessie, GA, I quite agree with you!

Jessie, unless another family member made a stink about it, I really don't think that there's a lot you can do, but if they were to go after the Dr, who went against the patients wishes, I do believe they Could press charges. Now how unfair is That? As in a time of Crisis, when seconds count, and the mistake is made to "do no harm", how could someone actually press charges, for trying to save someone's life?

It's a terrible catch-22, if you ask me! It does happen thou! Imagine being the long lost Son, who hasn't seen nor been involved in their Old aged Mother's care, for donkeys years, then he presses charges against a Dr? Imagine the Judge that has to hear That Case?!!! But they win, and that is why Malpractice insurance is so insanely costly!

I refused to take POA for healthcare. I will not make a decision and I wont be drawn into an argument on it. I think it is the hardest thing to do and I dont have the specialist knowledge that doctors have nor in this instance do I want it. They get the training ( and if I wanted to be unkind, they also get paid the money) that allows them to make sensible decisions. Therefore as I know nothing I am having nothing to do with it if the time comes.

Yea for cwillie. My Mom is 99 years old. She likes her friends, the food and activities of Personal Care, myself being with her every day (7 x 12hrs), attention from my oldest son who stops over after work, my bringing kitty in to snuggle and nap with her. I have it rough that the Personal Care facility has harmed her for which after each incident I am left nursing her back to health because of their failures, negligence and bad behaviors. Mother has always spaced out bad things happening to her or in the family, even when she was young. She does the same thing now. 100 is the new 70's.

PheonixDaughter your post is helpful to clarify a point of view, but the problem is way too many docs either think no one's quality of life is worth living unless they are under 65, buff and active, with no disability or chronic medical conditions in sight, OR the other extreme that it is unethical not to just keep everyone here on earth as long as possible no matter what or how. You can get informed on what basic things you say yes or no to might entail, but it is your values and your concern for your loved one's wishes and their autonomy they need form you, not the medical expertise.

Trust me on this. You want to know what a feeding tube, a ventilator, and CPR, do and do not entail and you want the authority to stop chemo, dialysis, or any other burdensome treatment that is not giving any meaningful survival to someone.

We faced this with my MIL; one niece thought a simple feeding tube in the nose meant you had to stay in bed and could not talk..most people do not know that a PEG tube (simple surgical or even interventional radiology procedure) may be perfectly comfortable and people can still eat what then safely can and want to by mouth; it may not make sense to do even that in the setting of advanced dementia, but for someone who can't swallow due to a brainstem stroke or a neuromuscular disease it is often a different story. They are supposed to explain the medical side to you, and you just have to be wary of value judgments or blanket statements that misapply what is true for one group of people to your loved one's specific situation. Sometimes the most important thing you are going to do is to tell and show them what your loved one was able to do before an illness, so they do not assume that an 80 year old grandma who was working in her garden and playing with the grandkids every chance she got was done with living and does not need to get antibiotics if they come down with pneumonia or meningitis.

tacy, please don;t take this as me being "pro" broken ribs and I am so sorry for what you went through with them, but both my daughter and I have had a couple and it was not by any means the worst pain ever. My metatarsal fracture and a couple ankle sprains hurt worse. I think your mileage may vary and depends on how many ribs and your pain threshold! My daughter was told not even to tape or wrap hers, to reduce the risk of pneumonia by not expanding that area well (but I think she did so she could get back out there as a firefighter), and I do not remember doing much for mine either. To be fair, I think I only cracked a couple, from landing on the edge of an icy concrete sidewalk while walking down a hill at work.

That said, skipping CPR for a very elderly person is not always wrong, epsecially if the occurrence is going to signal a heart just going out completely and not a reversible arrhythmia. For example, if someone had really bad pump failure (cardiomyopathy) and they are not a transplant or implant candidate, CPR would make very little sense; if they had a pacemaker failure it would be different. The chance of survival post CPR in the elderly is low, though not zero, and survival to hospital discharge even lower. You can specify defibrillator and drugs only and you can temporarily lift the DNR if surgery is going to be done.

Wanting to answer Tinyblu....
My personal experiences with ca lung are as follows:
My father wanted to live. He had a lung removed, lived another year until 66. He was able to complete one more tree surgery job.
My mother's husband, with lung Ca, refused even blood transfusions because of his religion, died within 3 months.

Vstefans couldnt agree more about the knowledge side of it - I absolutely wanted to know what the arguments for and against were and I could ask questions and they were answered. However, having been a decision maker once, I will never do it again, simply because I am not cut out to make those decisions and to be quite frank, a lot of people aren't ... hence me saying I wont be drawn into an argument on it. In this instance I am quite happy (happy not being the right word but I think you get my drift) to discuss issues with a doctor, and offer my views, which actually would not be helpful since I have had a DNR in place for ME for the last 2 years and an advanced directive, but it is up to the doctor to make the final call - I want nothing to do with that part. My father fought cancer for 6 years and they were the most miserable painful years of his life s bit by bit the cancer spread slowly, very slowly throughout his body....

Listen to the doctors and nurses. You can never stop someone from dieing. Eventually we all die and you cannot stop it. Do what is best for Dad. Have them put fluids into his system until he passes away in peace instead of experiencing possibly terrible pains and discomforts in his path to the inevitable. Pray to His creator for advice, He is right their with you.

Dee, grant you that the "disease" of being human has a mortality rate that eventually approaches 100% - but often death can in fact be postponed, for a short time, or a life time. Every intervention should be weighed by its own pros and cons. Chemo that will give you 2 months extra survival, while totally miserable with side effects, maybe no - chemo that will be miserable for 6 months but give you years may be a different matter. People who are in skilled care and will not be going home but love seeing grandkids and getting something out of being here should have reasonable interventions - people in end stage dementia who aren't getting anything out of life any more maybe should just get care that keeps them comfortable. Just my 0.02 - interventions are not all futile, though not always necessary or appropriate, grant you that too.

You cannot play God if you wanted to. God gives all life and determines it's span.

In my book, any decent, sane person should make up a living will when they are well. To refuse to recognize what could happen is just simply stupid and selfish. If they don't do that and something happens, than let the chips fall where they fall - they made their bed and now have to lie in it. In other words, it is THEIR fault what is going to happen - you did nothing wrong. Never let guilt overtake you. If people are stupid, then let them pay the price - they earned what they get.

Woo, Riley. That was a bit tough. We really have to use our best judgment if we are medical proxies. DNRs may have been signed 10 years earlier when death was not really considered relevant to the signer. They are signing something in theory. A good example is my parents. Both have a DNR and I am their proxy. My father was ready to go when it came his time, so we accepted the DNR and did not try to resuscitate. My mother, OTOH, has only recently begun to tire of living. I knew that before now executing the DNR if something were to have happened would not be what she really wanted. At the present time that is changing and I'll know that she really wants the DNR to be executed if her heart fails. It is the purpose of the medical proxy to guide the doctors in what the patient would want at that point in his/her life. We shouldn't say, "Well, you signed the paper, so it's your fault." We have to use some wisdom based on our knowledge of the person.

Tinyblu

I have been where you are right now. I was an only child, parents passed separately and I was left to make decisions for my father. This is the best advice I can give.

Your father: Think back over the life you have shared. Ask his PC doctor if they had this discussion prior to this time. Ask yourself if he is still competent to make his own decisions for Health Care. If he is still competent for his health care, your answer is his answer. In other words do what he wishes, even if they are outside your personal believes. During your lifetime were there ever occasions when you father purposefully entered into a conversation regarding what he would want. Probably this discussion would be at the time of a relative’s death. Try to remember if he had this discussion any other time stating his discussion. Speak with his clergy regarding this decision and listen to what they say. These things will allow you to make an informed decision.

About your feelings of being overwhelmed, this is normal considering your situation. I know I was at this time in my life. Get involved in a support group, even long distance caregivers will benefit from the experiences of others. The facilitator for this group should tell all at the beginning of the meetings 'what is said in this room, stays in this room'. See your medical provider, explain this to him/her and ask their advise for you. My doctor totaled me the best medical advice I have ever had. 'Set a time each day, it does not matter when and go for a walk. Each time you put your foot down, let that be the release for your frustration and anger'. I would suggest make sure you are in a safe place to walk. Many businesses and establishments offer a plan for walking to the members of the community at no cost. Being safe will give you the opportunity to truly focus on you. This is very important, for your health.

Truly, you are not alone. And there are people who can help. Tinyblu

I have been where you are right now. I was an only child, parents passed separately and I was left to make decisions for my father. This is the best advice I can give.

Your father: Think back over the life you have shared. Ask his PC doctor if they had this discussion prior to this time. And if he is still competent to make his own decisions for Health Care. If he is still competent for his health care, your answer is his answer. In other words do what he wishes, even if they are outside your personal believes. During your life time was there ever occasions when you father purposefully entered into a conversation regarding what he would want. Probably this discussion would be at the time of a relatives death. Try to remember if he had this discussion any other time stating his discussion. Speak with his clergy regarding this decision and listen to what they say. This things will allow you to make an informed decision.

About your feelings of being overwhelmed, this is normal considering your situation. I know I was at this time in my life. Get involved in a support group, even long distance caregivers will benefit from the experiences of others. The facilitator for this group should tell all at the beginning of the meetings 'what is said in this room, stays in this room'. See your medical provider, explain this to him.her and ask their advise for you. My doctor totaled me the best medical advice I have ever had. 'Set a time each day, it does not matter when and go for a walk. Each time you put your foot down, let that be the release for your frustration and anger'. I would had make sure you are in a safe place to walk. Many businesses and establishments offer an are for walking to the members of the community at no cost. Being safe will give you the opportunity to truly focus on you. This is very important, for your health.

Truly, you are not alone. And there are people who can help.

If someone is extremely ill, suffering, fading away, and there is absolutely no hope of anything good happening in the future to change that situation, then I feel you have no choice but to be kind and compassionate and do whatever you can do to end the suffering. It is the right and only thing one can do. Not to do this is selfish and uncaring and just downright mean.

The human body has an expiration date and, fortunately, we are blissfully unaware of that date! Does it really matter how old a person was when they signed the DNR?

When the prognosis is bad and the cure is worse than the disease, DNRs are supposed to spare the person (and his/her loved ones) from the torture of being kept alive by heroic feats and artificial means.

I was asked to sign a DNR right before being anesthetized with a ruptured appendix in septic shock. Not a very good prognosis but I refused and was then asked how much they should do. I told them they could shock me a couple of times and after that hubby would decide based on my condition. I do have advanced directives in place which were signed a number of years ago. If I should progress to the point where death was inevitable I would definitely sign and accept hospice

OMG Veronica! It used to be they RESCINDED DNRs for people going into surgery. Good for you for refusing. What are we coming to that life is so devalued that we try to end it sooner than necessary or appropriate?

I think a DNR decision should be something that everyone over 45 years of age should have to renew yearly and have it signed by a witness. If you are feeling really depressed one year and feel like you have nothing to live for it may seem like a good idea at the time. You may think differently next year when everything has improved and you are on top of the world. It may seem like a hassle at the time but at least your information will always be up to date and accurate and no one will feel like they are signing a death sentence for someone.

Mother was recently in the hospital. She made me POA over all her medical decisions. She was brought in for pnemonia. When asked my automatic answer is that it depends on the circumstances. I was holding Mothers hand and said I am not leaving her side. The doctor came in to give me a little lecture from the point of view of her age and fragility. She had pnemonia and no heart trouble. There is a prejudice that at near 100 the patient is dying and to let them die. No thanks if they are living. I stood firm to ask me at the time but I wasn't sure until afterwards the nurse said, CPR can be done in a gentle manner. Can an elderly person be revived without breaking there breast bone? There is not to much information out there. A DNR leaves no space for an elderly patient to survive if they could be revived in a manner the nurse suggested...gentle. Science does so much why can't they come up with acceptable resusitation for the elderly with frail bones or as the Nurse suggested for the Dr. to go as far as they can without the more violent means to restart a heart that can be used on a younger person. The right to life movement for unborn children is making headway. We need a right to life for the elderly. We are blessed every day by Mother being here on earth with us.

Mother was recently in the hospital. She made me POA over all her medical decisions. She was brought in for pnemonia. When asked my automatic answer is that it depends on the circumstances. I was holding Mothers hand and said I am not leaving her side. The doctor came in to give me a little lecture from the point of view of her age and fragility. She had pnemonia and no heart trouble. There is a prejudice that at near 100 the patient is dying and to let them die. No thanks if they are living. I stood firm to ask me at the time but I wasn't sure until afterwards the nurse said, CPR can be done in a gentle manner. Can an elderly person be revived without breaking there breast bone? There is not to much information out there. A DNR leaves no space for an elderly patient to survive if they could be revived in a manner the nurse suggested...gentle. Science does so much why can't they come up with acceptable resusitation for the elderly with frail bones or as the Nurse suggested for the Dr. to go as far as they can without the more violent means to restart a heart that can be used on a younger person. The right to life movement for unborn children is making headway. We need a right to life for the elderly. We are blessed every day by Mother being here on earth with us.

Daughterlu they can try and restart the heart with electric shocks but may need to put in tube to assist breathing but they do not automatically have to crush someones chest.
My answer was they could shock me a couple of times and then my husband who was right there would make the decision of how to proceed from there. I was warned that I might wake up with a tube in my throat and it might need to remain for a couple of days. My reply was "so be it" I had a ruptured appendix and was in septic shock both of which have a very poor survival rate. Wasn't ready to throw in the towel but hubby would not have let me suffer.

Thanks Veronica. I wrote that down on a slip of paper and will keep it in my wallet so in an emergency I will not be lost for words and congratulatioins on the success of your operation.

Dear Tinyblu,

I'm so sorry. Its an overwhelming decision. There is so much emotion and its always hard to know if we are making the right decision. After my dad had his stroke my siblings did not want any heroic measures. My dad did not want to be in nursing home. He wanted to be independent as long as possible. He was not the same man after the stroke. There were no more smiles or laughter. Just existing but I thought it was good enough. Then he had a series of heart attacks. He passed away in hospital. I wanted him to live longer. But everyone tells me that CPR would have been too violent. And he would have suffered more and it was better to let him pass peacefully.

I never wanted to be selfish. But in this moment four months after my father's death, I desperately want him to be alive. I wanted them to do everything and anything possible so that my sibling could have seen him one more time. Maybe this is not rational. Its a very heart wrenching decision to make. I still question if I made the right one.