I’m an EMT. There have been many occasions where I’ve had to go to a residence (and, sometimes, the scene of an accident) where someone is dead. The law in my state (Indiana) states that, if - when we arrive - someone(anyone, really…from a family member to a cop or firefighter) is performing CPR on the patient, we’re obligated by law to continue CPR all the way to the hospital, even if it’s an obvious death (cold body, rigor mortis, etc.).
In Indiana, a DNR (do not resuscitate) order is generally for the hospital. The law dictates that, for an EMT or paramedic, no DNR order specifically for the ambulance and/or rescue workers says that I have to treat as a non-DNR. If I arrive on a scene, and the patient is still technically alive, I’m obligated to continue lifesaving procedures until the doctor at the hospital “calls” the time of death. If someone HAS a DNR order, I have to actually SEE the DNR before I can opt not to continue CPR, etc. If the patient has a DNR, but the family cannot find the DNR order, we’re obligated to treat that as if there was no DNR to start with.
If no one is actively doing CPR when I get on scene, then a paramedic can officially pronounce the patient as dead. But we are obligated to err on the side of caution if there is any confusion.
I realize that this may not be specifically what the OP was asking, but I can see where it may relate, at least tangentially.
When my father had a stroke, we all realized he wasn’t going to recover, and it was up to me to instruct the doctors on what to do. Signing a DNR order was easy, and the hospital wasn’t going to smother him with a pillow, so that was easy. Between those two options were all sorts of details that I had to anticipate and puzzle through.
Did we continue nutrition, or let him starve?
Did we continue to treat his diabetes, or let his blood sugar go out of control?
Did we continue physical therapy?
What to do if he got an infection?
What if he showed some sign of progress?
Were those movements of his good arm some effort at communication, or were they involuntary spasms that needed to be restrained?
And on and on. My sisters and I spent six hours trying to ask and answer every question that might come up and ended up writing a seven-page directive. The social worker commended us on our thoroughness. Nevertheless, my father died a week later.
[QUOTE=jtgain]
Once a person reaches 100, lets say, no more medical care for you, only pain meds.
[/QUOTE]
My grandfather spent the entire afternoon of his 100th birthday at a big party. He spent his 101st birthday being interviewed by the local newspaper. He spent his 102nd birthday at a smaller party, fully alert and able to get around.
gonzo, covering more people under Medicare is going to make it cost more, not less. If you want to spread the cost out over more people, then we would have to start charging Medicare tax on more people. Your plan is much like the classic idea of “buy at six cents, sell at five, and make up the difference on volume”.
I have the sinking feeling that this is going to wind up another of those “bankers are ripping me off by charging interest on my mortgage”, but hope springs eternal.
You really don’t understand?" The people who are younger and healthier will pay into the system and not cost it money. Can you follow that far? Then go the rest of the way. Expanding Medicare to include all people will make the average cost of a person in the Medicare system cost less. Plenty of younger people pay into the medical system and do not use it much at all. Can you figure out why? They pay into insurance plan that just loves them. Of course if they get sick, the insurance company will do everything it can to jettison them. They are not in the health care business. They are in the profit making business. Health care is a vehicle for getting rich, not a health responsibility. They do not want to do a good job of reaching as many hurt people as they can. They just want to make as much money as possible.
Well, I had an interesting night. And it totally reminded me of this thread.
Paramedics brought in a woman who was found unresponsive with no pulse at home. Her husband had called them, so they started CPR, gave her drugs, and nothing happened. So they drove her into the ER where I was working tonight. (I’m not sure how long the ride took.) After 30 minutes of more compressions, putting in a breathing tube, more medications - and honestly, at this point, they were grabbing all us students and letting us do compressions, because nobody thought we could “save her” after so long, and it’s good practice for students - we got a pulse. For about 10 minutes, and then her heart stopped again. No DNR/Advanced Directives on file, so we had to “Code” her again. More drugs, more compressions. Got a pulse back again. There was vomit and blood and piss and shit everywhere. It took me over half an hour to clean her up enough for them to bring her husband into the room.
And there she is, a machine breathing for her, but her heart’s beating on its own. Pupils are fixed and dilated, no gag reflex, no corneal reflex. Woman is brain dead, but her Little Engine that Could of a heart is still hanging in there, thanks to the magic of automaticity - it doesn’t need a brain to tell it when to beat.
So now she’s in the ICU, and within the next 24 hours, her husband will realize that she’s not coming back, and he’s going to have to make the agonizing decision to take her off that machine that’s breathing for her. That poor, poor man.
One of my teachers once said that the *second *worst outcome of CPR is death. I understand now what he meant.
Please, if you don’t want to do that to your loved ones, talk to them. Tonight. Put it in writing. Please.