Who puts DNR’s on people and why wouldn’t the patients want to be revived should something happen to them? Is it a part of their religion? Or is it something else?
The patient decides on a Do Not Rescusitate order, if they are medically competent. The physician then writes the order, and the staff carries it out.
It is horribly cruel to bring someone back unwilling only to suffer more before dying again. Terminal cancer, end stage lung disease, cardiac pump failure, can all be terrible ways to expire. Yet we have the technology to perhaps bring a person back, for a few more hours, or days or weeks, only to continue to suffer without chance of actual recovery.
The rescusitation process itself is quite capable of doing damage too. Crushing ribs, bruising lungs, leaving a person in terrible pain after they had expired peacefully.
If the person wants to try to keep on living, that’s one thing. But to agree to die naturally, then be dragged back to the land of the (barely) living unwilling is too terrible. Yet it still happens too often.
All of my instincts tell me not to correct an attending, but I think Qadgop meant “mentally competent”. Otherwise he is right, as usual.
And you certainly don’t have to be a physician to know this. Topaz, you must still be young and healthy with family that is still young and healthy.
Thanks, ** Qadgop the Mercotan**, you have answered my question. If I was terminally ill, I don’t think I’d want to die in pain.
Sheesh-doesn’t ANYONE ever watch ER?
What happens if someone tries to change their mind at the last minute?
yup. thass itt. mentally.
I’ll leave the medical aspects to folks who know what they’re talking about, like Dr. Q, but I’ll comment on the legal/ethical aspects of it (while keeping it in GQ – debates on this can go into GD).
Generally, it’s considered a bad thing both legally and ethically to cause someone’s death. Criminally, it’s known as murder (or depending on the circumstances other homicide crimes such as manslaughter). On the other hand, if someone is dying, you generally have no legal responsibility to actively step in and save their life, unless you have caused the circumstances from which the person is dying or otherwise have responsibility for them.
Although it can get a bit fuzzy, there is a fairly clear legal and ethical dividing line between actively causing someone’s death and passively allowing them to die. When you have a terminally ill person in a hospital, this distinction can be important.
If an otherwise healthy person suffers from a disease or condition from which they can relatively safely and easily be revived and returned to a productive life, I don’t think that any medical professional or hospital ethics committee would authorize a DNR order (putting aside the case of those whose religious beliefs prohibit medical intervention).
On the other hand, sometimes when a person is suffering from a terminal condition, a rescusitation would only extend the duration of life, but not improve the quality of life. In those cases the patient (if competent) and his or her family and medical providers can come to the conclusion that if the patient is dying of natural mechanisms, no aggressive mechanisms will be undertaken to revive them. That’s a DNR order.
If I were terminally ill and I know I am just going to live a few months in pians an then die again anyway, what is the point? I mena at some point you have to consider quality of life. I would not want to be brought back again and again until I were a veggie.
I imagine if you have a DNR, but are able to get across to your caretaker at the last minute that you changed your mind, they would try to save you. DNR is supposed to tell them your wishes once you are unable. If you are still able to tell them your wishes, then they will err on the side of keeping you alive.
IANAD, but to my mind that could be a difficult spot for a caregiver. You have an existing DNR, but at the critical moment you tell them “Save me” and then pass out. They start to work, but only one person heard you. Now others come in to see what all the commotion is, and have a doctor trying to revive a DNR. Any doctors or medical ethics professionals care to comment?
My mother carries a DNR with her, and has for… oh… over ten years now. Not doctor imposed - self-imposed.
You see, my mother has this terrible problem with heart disease. She has had at least 5 heart attacks (possible even more, as “silent” heart attacks) two hear surgeries and a stroke. Her plumbing is clogging, see, nor does it affect just the cardiac system but her entire body.
She’s actually had it since before her second heart surgery. After the first one, you see, she was insistant that she was NOT going to go through that again, had all sorts of legal papers drawn up.
So, some years later, she’s in the ER and the doc there is INSISTING she get more surgery and she’s saying no, you can’t do that. And he’s maintaining that she must be crazy and that if she was in her right mind she’d consent but between my father and her regular cardiologist they convince the ER doc that no, she really doesn’t want this, she’s said so for years, has legal papers (actually had them on her!), and yes, she’s serious.
So they basically warn her again that she’ll probably die, blah, blah, blah, and she says she knows, then they park her in a corner and do what they can to “make her comfortable” that doesn’t involve surgery or a respirator (she doesn’t want one of those, either.
And that’s when dad gets to work on her, telling her he loves her, that’s she’s being unreasonable, and lots of other stuff until, after about 6 hours (they’re both quite stubborn) she says, alright, she’ll have the surgery after all. This time.
At which point they drag a bunch of witnesses into the room, including a hospital lawyer, and she writes out and signs that she gives consent, and she has the surgery.
And they had to show her that piece of paper after the surgery to shut her up about having her legal wishes “violated”.
Anyhow, she still has the damn thing in her purse whenever she goes out. Basically she fears going the way her mother did - subjected to round after round of CPR, including broken ribs, a punctured lung, and so forth (CPR can be quite violent). Nor does my mother wish to be revived from a massive heart attack or stroke to live the remainder of her years on the intellectual level of a zuccini. And she hates those respirator things wth a passion - I suspect it’s because it’s completely impossible to smoke with one of those things installed.
Honestly, I’m not entirely sure that what she has is, officially, a “do not resusitate” order but she sure has made her wishes known for a long time now, and has even gotten paperwork to that effect.
The real motivation here is that she doesn’t fear death (as in being dead) nearly as much as she fears how she is going to die.
Why would someone do this? I’ll give you a concrete, awful example.
My grandpa had a DNR. When he had a stroke (while being in the advanced stages of Alzheimer’s), the paramedics were not told, and they brought him back. So he essentially starved to death because he didn’t wake up to eat, and his standing orders were against IV feeding.
I wish he’d just gone with the stroke.
My 102-year-old great-grandmother has a DNR, and for good reason – she is obviously VERY old and quite frail, and is pretty much ready to go anytime God wants her. Her general health is excellent for her age, but she IS 102.
Her DNR is posted on her fridge, and EVERYBODY who might be involved if the situation comes up (this includes local people and those of us who are scattered around the country) knows about it. Any docs or emergency personnel who insist on trying to bring her back will find themselves with a Very Angry Family coming after them, and some Very Serious Lawsuits!
Thank you, everybody for your personal examples… I was wondering about this for a long time.
NIT NOTE:
I’ve struggled to refrain from doing this, and I lost.
It’s spelled “resuscitate”.
I know, I’m a filthy Nazi and should be tossed off the site.
Heil Merriam!
Heil webster!
Yes, but do you have spiffy brown uniforms? 
Dunno. But I’ve thought about doing what one Doper mentioned: Having the words, “Coroner, please try CPR one more time.” tattooed on my chest.
My mother in law was suffering terribly with emphezema. She has a DNR posted right on the wall next to the sofa where she spent her time.
Her quality of life was such that her greatest challenge of the day was to find the breath to make it from the sofa to the porta potty before she made a mess of herself. Once she was there, the effort required to “go” was tremendous. She had no oxygen in her blood.
She knew the time was near, and she did not want to prolong what was a terminal, miserable condition.
When her time finally came it was like someone turned off a light. She was just no longer there. It was such a better end than if she had to suffer gasping for breath for weeks or months longer.
I think what this comes down to is that just because doctors CAN do something – and they can do many, many amazingly wonderful things – doesn’t mean they always should. But since they are legally required to try, if you don’t want to be resuscitated, you have to make that desire official.
Two other excellent things to have.
- An Advanced Health Care Directive – commonly known as a “living will.” This legally executed document details exactly what your wishes are as to tube feedings, antibiotics, respirators, pain remedies, and all the other possible treatments, in the situation where you are unable to express these preferences for yourself.
- A Durable Power of Attorney for Health Care. This legally executed document names a primary and alternate person who is authorized to make ALL health care decisions for you when, and only when, you are unable to make your own wishes known.
Both of these were beyond price last year for my sister and me when our father was in the hospital for what turned out to be his terminal illnesses. At one point we needed to specify whether the doctors should attempt to fix the blocked blood vessels in his leg, since the poor circulation had caused one foot to become gangrenous, or to simply amputate the leg, knowing that due to cardiac problems he might not survive the surgery. And that was just the beginning. Both documents were extremely important when the nurses and doctors balked somewhat at giving additional painkillers when he was in serious pain. We were able to point to the exact lines in his living will that specified what to do, and the situation was then dealt with exactly as he would have wished.
Not a pleasant subject but an issue that will save much physical and emotional agony at crucial times.