Parents can sign a DNR, too. I almost did for my two week old son earlier this week. As to why: after suffering some brain damage, the doctors weren’t sure that he’d ever be able to breathe on his own, or that he’d have anything approaching normal brain function. Fortunately, neither seems to be the case. For us, it has nothing to do with religion; we’re both athiests.
Manatee, I hope you have the best possible outcome with your son. What a nightmarish time to live through
My partner’s grandmother had a DNR, and senile dementia. She got pneumonia, her daughter was called and against the rest of the family’s wishes agreed with the aggressive doctor on call who had never seen her mother before and had treatment. His grandmother lived for another 2 years with great suffering. I really wished that the doctor who saw her that night and pushed for treatment had come back and seen the results.
There are lots of good reasons to have a Do Not Resuscitate order. No one denies resucitation is a good thing if after an event there is no mental or physical cost. This often is not the case. Hospitalized patients with acute medical problems have a 10-17% chance of surviving to discharge after CPR. (Murphy DJ, The influence of the probability of survival on patients preferences recarding CPR, NEJM, 330:545-9, 1994). Some 25-50% of survivors have residual functional deficits. (Fitzgerald JD, Archives Internal Medicine 156:72-6, 1996 and de Vos R, Arch Int Med 159:249-54, 1999). Patients grossly overerstimate their chance of recovery, perhaps precisely due to shows like ER which show a much higher success rate for resucitation than is seen in practice. Reported overall survival rates after cardiac arrest outside of hospital vary from 1.4% to 18% (Ballew, BMJ 324:1462-5, 1997.) and a Scottish study found only 40% of patients discharged from hospital had no neurological consequences. (Cobbe BMJ 312:1633-7, 1996). A study from Toronto’s well-known Hospital for Sick Children found only 15% of out-of-hospital cardiorespiratory arrests survived to discharge and all had neurological deficits (Schindler, NEJM 335:1473-9, 1996).
The extra cost and indignity is not worth it when the chance of having no physical or mental consequences is low. Not having a CPR places families who want the best for the patient in a very difficult position, one I’ve had to address many times. Be careful, though, in making sure that “Do Not Resucitate” is not the same as “Do Not Treat”, though, since these are completely different concepts.
I agree both of these too are very useful. Mom had terminal brain cancer and had all 3 done before she
slipped into a vegetative state. I was on her PoA because Dad wasn’t always there at the
hospital/hospice where she was at… I usually got the call to give consent for procedures. I was amazed one day that they had given her an oxygen mask when it was instructed not to. If I wasn’t on the PoA I couldn’t have told them to take it off.
It is also useful to have a Durable Power of Attorney for financial matters also. She was an officer in
corporations held by her and Dad… and it helped to be able to move funds around and to pay her bills
when she was no longer able to sign legal documents and checks. Mom was in a non-functioning state
for around 6 months… in which time Dad sold their old house and closed several business deals. She
died last Halloween.
Side note: We once joked that I needed to buy a big Sharpie marker and write in bold letters, “DON’T
EVEN THINK ABOUT IT!” across her chest. hehe
You laugh. So do I. Bwa ha ha ha ha ha! But the fact remains that the emergency room/hospital doctors only know about the advance wishes in something like 20% of the patients who have them. I think the Sharpie idea is excellent!