Without a written DNR order, what else are paramedics going to do?
Initiate lifesaving, and maintain that until an MD says to stop is the only option.
But it’s possible they did it as a “slow code”, going through the motions with no intent of actually reviving her.
EMTs see what happens in cases like that, and they are human beings like the rest of us.
What Whynot said.
Real life, especially end of life, is complicated. I oversee hospice patient care, and the particular dysfunction described in this thread is just one facet of the complex world of dying in our society these days.
My own father in law did not want to be resuscitated if his implanted defibrillator didn’t bring him back. But he refused to sign a DNR despite that, and when his defibrillator didn’t bring him back, EMTs worked on him, took him to the ER where the MDs worked on him, then finally declared him dead.
They have to do what is required of them. I have no beef with them for doing that.
Canny paramedics will see the reality of the situation in many cases, and be able to adjust their actions accordingly to technically conform with laws and do the right thing. But determining what’s really going on can be tough, at a moment’s notice.
I don’t believe there is any need for an investigation unless the death was sudden and unexpected. For the elderly and those known to be terminally ill where there is no suspicion of foul play, the police won’t do anything unless something suspicious should arise after medical examination.
Whether or not to call 911, and when to do it, may depend on considerations described previously in the thread. You could also call the person’s physician if they are available to determine what to do.
My grandmother, who was 96 and had had a previous stroke, died at home. I understand the police came to the house, but once it was determined that she had been under a physician’s clear they had no further concern with the death.
Back in my private practice days, I’d get calls from the county medical examiner, asking me if the deceased had been under my care, and if so, was I willing to enter a cause of death.
If I was, that generally ended any investigation idea. Unless they had bullet wounds or similar.
In my current public practice, all my patients get autopsies automatically. We rarely find anything surprising on them.
Speaking from my own experience, if your terminally ill aged relative expires on your watch, be aware that even if there is no attempt to revive them by the medical personnel who arrive at your house, once you call the professionals you are basically powerless to affect anything that happens next. If you would like to sit by the body for awhile, for example, do it before you call anybody. You won’t get that chance otherwise.
Resuscitation procedures can be very invasive. My friend, who cared for her terminal, essentially demented husband for years (the dementia came on before the cancer), had him die on her in a hotel room. The guy was solidly dead, but the paramedics cracked his chest open, stuffed tubes down him, and generally abused a corpse for quite awhile before they gave up. It was awful for her. If she had just said nothing until he was at least tepid, it would have been much more peaceful a departure.
When my farther in law died he was at home under hospice care. So we called the hospice and a Nurse came over and verified that he was dead and took care of calling people to pick up the body. There were no police involved and 911 was not called.
Unless the paramedic personally knows the patient’s wishes, the right and only choice is to resuscitate in the absence of a DNR. The alternative is making it too easy for a manipulative adult child to lie and say, “He didn’t want to be resuscitated,” and laugh his way to the bank. I’m sure that doesn’t happen often, but it doesn’t never happen either.
Given that the rate of successful resuscitation out in the field is significantly less than 3% (and if you’re looking at meaningful survival, like return to some sort of aware existence lasting longer than 2 weeks, think less than 1%), it certainly doesn’t happen often.
“Rarely.”
I haven’t said it in too long, but I love you, man.
When the old Scotsman woke to found his wife had died in the night, he frantically rang for the servant. “Mary! Mary! Ye only need to boil ONE egg this morn!”
I have been through this situation* twice recently and this is my experience as well. It’s a sad thing to think about, but when it happens you only get one chance.
*family member dying at home from an illness, suddenly but not entirely unexpectedly
At least, nothing surprising you didn’t already know about, right? (Remembers Mr. Bagel-Dog Penis…)
That was in my early days. Such things don’t surprise anymore. Not even Musical Anoscope man. (You’ll have to visit youtube for a further hint about that one.)
I remember that! There was a thread here about it as well.
(Hey, how is **elfbabe **doing?)
And if one is to follow those good meaning instructions then one would also keep said instructions under ones hat, IMO
Not long ago I was called on the carpet for stopping CPR on a terminal cancer pt. that arrested and 1st responders (fire rescue) had started CPR.
i had a little chat with the family and they did not want resuscitation even though there was no DNR orders.
I actually just failed to follow protocol of calling medical control and running a ECG strip proving asystole (flat line).
In that case CPR was initiated out of emotional reaction to one of their own rather that the responders reacting to a possible viable person.
Afterward the responders agreed that they had acted as stated and I wrote my required sentences on the dry board.
We had a DNR for my grandmother at her nursing home, and they still went ahead and resuscitated her. Then we had to go through the whole process of having her taken off the ventilator.
When my father had cancer and was in the final stages, we were instructed by hospice to not call 911 as the doctor had already stated he was terminal with only a few days left. The arrangements had already been made with the funeral home, so we called them to come to our house.
My mother was an RN, and I’m not sure if that was the reason that they didn’t require another nurse to come and verify that yup, he’s dead.
As long as there weren’t any bullet holes, I suppose we could have ended things a day or so earlier without anyone knowing.
Call 911 aka police. We did this when my mother died at home last fall. Because a hospice nurse arrived for her appointment shortly after Mom passed, she was able to attest to the care and perform an examination so no one else was needed to call. In fact, she even coached me through the call to the police so they wouldn’t arrive with lights, sirens, and the associated hoopla.
Afternote, the nurse made sure we mentioned the DNR orders and that she was on hospice care. They were still wanting to send everything with lights until I mentioned the nurse was present and had examined Mom.
When my grandfather died 9 years ago, in freaking hospice, my aunts and mom had to fight like the dickens to avoid an autopsy. Why? Because my grandmother had gone back into the room with him alone to see him for one more minute before going home to get some rest, put her hand on his heart, and felt it stop beating. And so she was alone in the room with him at the moment he died. And so the hospice people somehow thought she had unplugged him, I guess? Never mind the multiple strokes and multiple organ failures he had been experiencing over the previous few days…
My brother in law died of terminal cancer in hospice a year ago.
The doctor said “it won’t be long, maybe a few hours, possibly less - do you know what funeral home you are using - it will be best to call and let them know so they can make sure a hearse is available or it might be hours before they get here”
As the sister in law (this was my brother’s husband) I got all “arrangement” duties at the end. So I called the funeral home my mother in law had chosen to find out what they needed me to do and “alert” them that they would need to pick up in a few hours. Unfortunately, it was Sunday. The person who answered the phone had no clue what to do. She couldn’t tell me what to do. It was horrible.
(What needed to be done was once the death happened, the hospice would fax the death certificate to her, and she’d dispatch a hearse. I knew this, what I was trying to get through to her was “I’m giving you a heads up because I don’t want my mother in law spending six hours waiting for you next to her son once he dies.” She also needed to pull all the pre-planned paperwork, and if there was additional paperwork to fill out, she needed to get that faxed over to me so I could fill it out. That I didn’t know - she didn’t either.)
He passed a little over an hour later. I called the funeral home back once the death certificate had been faxed over to let her know “earliest possible” (some people do want to sit with the body for a while), and we got him out about four hours after his passing - seems she hadn’t arranged a hearse and had to call another branch and find a team. Which is why I was calling - find out who is off at planned funerals, and who you have waiting for pickup.