My mother’s gerontologist very tactfully told me that a Do Not Resuscitate order would be appropriate, that in my mother’s frail condition any resuscitation could cause broken ribs, and other after effects making her remaining life a misery. Mother has late onset Alzheimer’s and is in stage V. Other than the Alzheimer’s she is in excellent physical condition for 92, but the alzheimer’s is going so fast, I think she’ll be in the final stages late this year. She’s had some bad falls but her dance training taught her how to fall so no injuries, but I finally got her to carry a cane ‘just in case’.
I have her Durable Power of Attorney, can I sign a DNR? Do I need to go to court?
For an Alzheimer’s patient, I would suggest you go over a MOST form with your mother’s physician. In addition to DNR it includes instructions on how aggressive to be with other interventions and can be changed as her condition changes.
I was offered one of these when the DNR issue came up for my mother. I declined it because at that point it was clear my mother’s condition would only worsen (IIRC she was hovering at Stage 5 at the time). I just had the DNR with the physician’s signature.
Well, as an ER physician, I can tell you that having more direction is helpful. For instance, if a patient comes in with a fever and low blood pressure, I will give fluids and antibiotics regardless of DNR status. That really only applies if they stop breathing or their heart stops. But if there is a MOST form directing me to provide comfort measures only, then I can more confidently follow the patient’s wishes.
Word. As a home health nurse, it would also help me decide whether I’m calling an ambulance or the primary care provider when I see a patient in trouble at home. If you want to die at home, that’s great. I want to die at home, too. But without these properly completed and signed by your doctor documents, I can’t let that happen. (I emphasize the “signed by your doctor” part because I’ve been handed a lot of DNRs without physician signatures, and those are good for firestarters.)
Not every state uses the MOST form. In Illinois, we have the POLST.
This site has a good listing, with links, of the MOST/ POLST forms for your state. While some of their links need updating, it will at least get you started to figure out what you need to be looking for for your state. State-by-State POLST Forms
That reminds me. The MOST form (which I’d never heard of until now but looks useful) does not talk about various other life-prolonging treatments. Years back, I read an article by a reporter whose father had advanced Alzheimer’s - and had a pacemaker. Ultimately they turned off the pacemaker; the father didn’t die of the cardiac issues but it might well have kept him alive had other issues not taken him first.
That inspired me, when I wrote my medical directive paperwork a few years back, to include extra instructions for things that would prolong my life if I was not able to give informed consent - e.g. things like routine mammograms, colonoscopy, pacemakers and so on. I made it explicit that these things could be skipped or stopped unless their intent was solely to make me more comfortable.
Basically it boiled down to “If it makes me comfortable, do it even if it prolongs my life. If it is solely to prolong my life, don’t do it unless avoiding it causes me distress.”.
How would such a document be used in conjunction with the MOST form - which seems to deal largely will urgent illnesses?
Your advance directives help to guide your physician and your decision maker in how to make the choices you would make, if only you could communicate them. But they’re not legally binding. If your decision maker decides that you need that mammogram, they can sign the consent forms to get you a mammogram, even if your advance directive says no thank you. But an advance directive is a “what-if” kind of document. It’s what you would want, if certain things happen sometime in the unknown future. All adults should have one, regardless of their current state of health.
The DNR and the MOST/POLST are physician orders. They’re usually not filled out until you’re in a state of advanced illness or medical emergency. They are as binding (and protective) on all the other healthcare providers as every other physician order. It’s not a “what-if”, it’s a “here’s what we’re doing now that we know what we’re dealing with.” A physician and you and/or your decision maker can use your advance directives to help guide you in creating your MOST/POLST.
Good explanation of the difference and why you’ll likely eventually need both but probably don’t need both today here: POLST & Advance Directives - POLST
I have DNR, and I’m in perfect healthy, but old. I’m hoping a sudden-onset event or accident will save me the trouble of finding a way to commit suicide at a later date. I don’t want the bastards waking me up to make me plod on to an undignified and painful death.
I’m pleased, but a little surprised, that your doctor was willing to sign a DNR while you’re perfectly healthy. Mostly, they won’t, until you’re at the point where they wouldn’t be surprised if you die in the next 12 months.
I don’t want CPR or ACLS done to me, and I’m only 42. But I’m helpless to prevent it at this point. I haven’t been able to find a doctor willing to sign for me, not even the ones I work with professionally.