Not to be resuscitated

[JaneS]

It is not that we actually encounter this in our work (I hope), but I thought it might bring up what is to me a disregard for a stated non-treatment choice.

I am a volunteer member of St John Ambulance and attend some fairs, sports events etc as a first aider. I was not involved, but there was a situation where a lady needed resuscitation - except that she had a bracelet stating 'NOT TO BE RESUSCITATED'. In Australia, at least, I understand that this is a legal document with one's doctor and that emergency personnel cannot act on the request without discussion with the doctor. Therefore, first aid, state ambulance and others capable of rendering resuscitation must proceed until the doctor is contacted and consents for attempts to cease.

If the person has clearly stated his/her wish, why should this not be respected? If the patient is resuscitated and taken to hospital alive but sustained brain damage in the meantime due to anoxia, this is the outcome they obviously intended to avoid!

What are the experiences of other people in this regard. I find it an ethical dilemma.

Jane

[cathyph]

Jane,
Several years ago, as my father was beginning his long descent to death in ICU, he hit a critical episode and began telling us in every concrete way possible: "I want to die." He already had a DNR (Do Not Resuscitate) order on his chart. The hospital's position was: he needs a psychiatric evaluation to determine that he means this. Their default position is: ignore it. It's a CYA legal maneuver. We encountered similar difficulties with my mother's nursing home. In spite of all the documentation regarding HER DNR, the home was prepared to ignore it, for their own protection. We had to jump through more legal hoops to make them agree that they would honor it. Only time will tell. So people may think they are stepping up to take some small control of their final events, and yet the DNR is considered irrelevant to medical organizations. It's an awful situation.

[Diane]

This is a perennial theme in every hospital show on TV.
The best example I've seen was in the film, Wit (http://www.cduniverse.com/productinfo.asp?pid=1969869). Emma Thompson's character is dying of end stage ovarian cancer in a research hospital. She is clear about the DNR. Yet, her wishes are ignored by medical researchers who bring her back in order to study their treatment protocols for just a little bit longer. Finally, a nurse who has become close to her stands up for her, and blocks further attempts to revive her, and they let her go. Great, great film. Absolutely spellbinding.

[Jon Newman]

Hi Jane,

I found this statement (http://www.acep.org/practres.aspx?id=29182) from the American College of Emergency Physicians.

From the statement,

A valid DNAR order or other directive consistent with local policy, is immediately availableI don't know whether a bracelet is considered a "valid" order. If not, why do they exist?

I also have a difficult time appreciating the difference between a DNR and a DNAR.

[Bas]

In Ontario, there is a agreed upon document (MDs, paramedics, nurses, emerg depts) that has to be filled out by MD with the patient, sigend by MD, pt, and power of attorney. Thsi document is bright orange, and automatically respected by the first-on-the-scene. It is legal, stands up in court and is binding.