“Do Not Resuscitate”—Let’s Talk about CPR

Originally posted by OtherSideOfTheCoin
reply to post by ohioriver

 

You see that is an oversimplification.

Let’s suppose we have a 73 year old man with full blown metastatic cancer and other core morbidities (say dementia and diabetes) he says he wants CPR and the family also say they want CPR.

CPR for a patient like that is not going to be successful because as much as he might want it the best possible outcome is for him to end up on life support which will eventually have to be turned off, we cannot keep a person indefinitely on life support. As such after a couple of weeks his machine will have to be turned off and he will die because the cancer at that point has won and he is now dead.

In that instance CPR is not the appropriate course of action and while the family and patient might not see it that way the more objective medical staff will see it that way.

Essentially medical staff have the right to withhold treatment if they can justify it, which in the case above they most certainly could.

That is the key difference, withholding treatment is not murder, by not giving CPR we are not taking another’s life or doing anything that will kill them. Rather what we are doing is withholding a treatment that is not appropriate.

So why bother even giving them any meds,...or lets be clearer. Why bother giving them any food.

Just let them expire in a closet somewhere.

(I get what you are saying, but I dont agree)

reply to post by smirkley


Well we keep giving them meds food and whatever other care they need to maintain the quality of life that they have.

Say for example that same guy lives in a care home quite happily on 20 pills a day and needs someone to feed them, fine, we keep doing it and I can see no reason not to do it.

Say that he then has a massive heart attack, their needs then drastically change and to keep them alive would need to be on a life support indefinitely, fed through tubes, pee through tubes, and breathe through tubes. There is no quality of life in that, and after a week we’re going to need to turn the life support off anyway if there are no reversible factors.

Interestingly in the area I work we have a do not attempt CPR form but there is a clause in the form that stipulates what the patient, family or doctor want in regards to escalation of care. That means you might not be for CPR but you are to have absolutely everything else done to keep you alive, that is the case actually with most patients on a DNR.

also what dont you agree with?

Great to see some hands-on nursing perspective to counter-balance some of the discussion happening elsewhere.

Real easy to have an opinion without experience.



No doubt there are Nurses who are only in it for the paycheck...but from what I've seen over two decades its a tinsey tiny percentage...like count on the fingers of one hand...after an accident with a bandsaw...but then again I do hope people understand that speaks more about those specific individuals rather than the entire Nursing fraternity...and those individuals would likely be useless in whatever profession they entered anyway.

Anyone doubting that only needs to take a peak at my bank balance to see I'm soooo not in it for the payday - heh, sometimes wife (who is also a Nurse) and I are living from payday to payday...


Nurses - and so many of the other frontline staff like Nurse Aides/HCAs, Support Staff, Lab Staff are some of the most undervalued and under-resourced parts of the whole system...and yet to be fair we're pretty much the cogs it all spins on day to day.

We're damn good at what we do, damn committed, damn passionate and will take it to the enth degree.
Thats who we are. Thats why we're Nurses.



One thing some seem to get twisted is this concept that the Nurses (and other medical professionals) role is to sustain and/or save life.
Yeah, without a doubt thats part of it...certainly not the whole though.
Its to provide *care* yes...but that also includes providing *compassion*, *connection*, *consideration*...sometimes through providing those it can look, to 'outsiders', like we're not providing one or more of them. That would be quite a mistaken perception to have.


Its been said many many times its not as simple as 'save a life'.
I'd argue in many ways its also the seemingly incongruent position of both being part of keeping someone away from deaths door and being part of the process of a persons journey through it if thats how it unfolds.


Thinking back on the people/patients who have impacted me the most, who sit in my head as reminders of what and why we do this - yeah, theres a few who were snatched from the clutches...and absolutely thats celebrated.

There are those who despite all efforts just didn't make it...who sit there like a thorn under your skin with all the 'what ifs' and the 'coulda, shoulda, woulda' questions we always seem to beat ourselves up with.

But there are also many whose greatest impact was not the saving, but the soothing as they passed....people who had - and this sounds so cliche and even a tad disrespectful to even attempt to put into words - allowed me to be present as they passed.
That's a gift of grace that no person can ever describe or devalue either.



...really isn't so black and white...

Originally posted by OtherSideOfTheCoin
reply to post by smirkley

 

also what dont you agree with?

I should clarify two things that may clear up my statements.

1 - I believe all life should be preserved at all costs. (short of a legal DNR, under a doctors decision of course).

2 - My statements are primarily about the woman that did not get CPR at the Glenwood Gardens senior living facility in Bakersfield California most recently, without a DNR. I realize (and should have first before posting) that your opening post was not directly regarding that instance, so I would like to partially retract some of my comments, provided my first point is taken in general.

reply to post by OtherSideOfTheCoin


Yup...picking every country has their own variations.

Here in NZ the Docs/Specialists can still make a call...and if needs be over-ride any DNR, they aren't so set in stone...providing they can back up their rationale for doing so if/when they get asked to.


That can of course be just as fraught with problems as following strict policies on such things as DNRs...policy Vs personal motivations...


For instance, thinking of one instance of an elderly person who had a DNR and the Dr making the call to override it...despite everyone else in the room saying to let the old guy go.
Yeah...wasn't pleasant at all to watch, listen to, smell etc...and less so for the person nor their son who was outside the room.
That old guy passed...but they also passed in a HUGE amount of pain directly relating to the actions/call of that Dr.


Docs rationale: "I had to try"

My internal response: "Well. As long as your conscience feels better about it. That old guy didn't, nor did his son who sat next to him as he died painfully. But hey, well done Champ!"

I think the most important aspect of this thread, is that it may get people thinking and talking about what they and their family members want done or not done to prolong life, and under what circumstances.

For me the key word is quality. I am a retired nurse and life sometimes is very much worse than death. Death is often an end to suffering. Being old is tough, it hurts. Being dependent is worse it is humiliating and stressful, big thrill of the day is meals unless you can't feed yourself, then it is just another way of reminding you of what you don't have.

If my heart stops and I am under those circumstances please don't save me.

As for families, many think only of themselves and not what the person is or will go through, selfish. Talk about it while it is not an issue, then when the time comes, will still be painful, but at least each members wishes can be respected.

Doing CPR causes cracked ribs and with the mouth to mouth breathing, the individual doing the resuscitating risks infection. Some might also puke in your face. Most people don't know how to do CPR and will probably do more harm than good, which could involve a lawsuit against the good sumaritan. Are you willing to take the chance?

During attempts to revive someone...he screamed "Dont! Dont! Please, dont! My wife is waiting for me over there" he gasped pointing at the empty corner of the room. (she passed years before him). He did not survive our attempts...even with the AED.

Other than them having a DNR order, its always a hard call...so you try your best, hope it works and it's what they would want.

reply to post by mysterioustranger


My last resident who died did that, his mobility went down hill very quickly and when I went to check on him at the start of my shift he was delirious in his chair and his breathing and heart beat was erratic so we got an ambulance and I went to hospital with him.
When in hospital he fought with the nurses trying to put a fluid drip in him saying "No No my wife wants me to go with her" pointing at one corner of the room then he just closed his eyes and died.
I just hope it wasn't a delusion and he had his wife waiting for him somewhere.

reply to post by boymonkey74

Hey friend...thanks for replying. Its tough we know and never gets easy for us to let them just go. I really do believe they "see" the other side at the moments prior to death.
Thanks again....

MS

reply to post by ohioriver


I know you don't work in health care....because someone does not receive CPR is not murder.....
I am also in Ohio, we don't allow our Doctors to have the final say in the US, but we should. I have seen multiple cases of family members who can let go and a patient who wants to go...We will do everything a POA says to do to keep a body alive....but often nothing is left of that person....its sad, but it is reality.

Originally posted by zbeliever
reply to post by ohioriver

 

I know you don't work in health care....because someone does not receive CPR is not murder.....
I am also in Ohio, we don't allow our Doctors to have the final say in the US, but we should. I have seen multiple cases of family members who can let go and a patient who wants to go...We will do everything a POA says to do to keep a body alive....but often nothing is left of that person....its sad, but it is reality.

I see a lot of justifying on here. If someone deliberately does something they know will cause your death, it is murder. Plain and simple. Its one thing to have a DNR, but to decide who gets to be saved based on ones own personal interpretation of what someone else's life is worth is wrong.Life is precious, even if its only for 2 weeks. I am so sorry there are so many people on here whose moral centers are so off-kilter. It is not OK to treat the ill and elderly that way.

Edit to add:

"""we don't allow our Doctors to have the final say in the US, but we should""""

Are you kidding!!!???? God I hope so.

www.time.com...

Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually.

And just think, thats just their handwriting. Let me guess, you are in the healthcare field. I just don't place that much faith in a docs ability to make crucial judgements on whether he should save someone or not.

reply to post by OtherSideOfTheCoin


Hello OtherSideOfTheCoin,

I work for several organizations in Belgium concerning palliative care and euthanasia... My job mostly involves the ethical side of the coin, and I help organize training for medical professionals in this field. Euthanasia has been legal here since 2002, and is already very well accepted by our population, especially the Flemish (By the way, doctors are the slowest in accepting this.). Other laws concerning end of life care and patient rights were also signed then. We have several official documents that anyone can fill in and register concerning their wishes after they lose their "sound mind and judgement". Here is a list of them on the LEIF - LifeEndInformationForum website (in dutch):

leif.be...

Just last month, LEIF introduced a card which looks just like a bank card so you can keep it in your wallet. On it is your name and Id-number, and a short list of the documents you have registered in your name. There is also a phone number on it that connects to LEIF, which has a copy of those documents. This genius idea was introduced to the press last month and since then, LEIF has been flooded with requests for this card. They had 4000 e-mail requests in the first 3 days alone, and the phone has been ringing non-stop... They are desperately trying to find people to help them complete all the orders.

I agree with you that a doctor has the right to decide in a critical life/death situation, but, and that's a big BUT, this is only because the patient is unable to. If a patient wants to receive CPR, even if he is going to be a vegetable for the rest of his life, so be it. He may choose to do so out of ethical, spiritual or religious reasoning. That's what this whole discussion is about: The right to your own body/being. I have met too many doctors who think they know better than the patient what is good for him. Usually that will show in a lack of information given to the patient, but it is often much worse than that... I am sure that you, as an experienced medical professional, can imagine what I am talking about.

soulwaxer

Good thread ... good discussion.

I have made it very clear to everyone around me ... NO CPR EVER and DO NOT RESUSCITATE EVER. And I've got written instructions that I should never receive any organ transplant either. When I'm dead then I'm dead and let me move on to whatever is next.

I have autoimmune, neurological, and eyesight issues and other things going on. I feel bad every day. It's tiresome. I'm looking forward to what is next and being released from this body. I want to go without interference from anyone here.

I also support doctor assisted suicide. Any adult, anywhere in the world, should be allowed to end their own life painlessly and with dignity at any time they wish. Three years ago I started this thread here at ATS to discuss it.

One last thing .. don't judge me and my position unless you've been in my shoes.

reply to post by FlyersFan


Question (BTW I completely agree with you)
What is stopping our governments bringing in laws that would help people who want to be assisted in their passing?
I suspect it is religion but I would like to hear your thoughts.

reply to post by FlyersFan


Thank you very much for posting you views and your story I found it very interesting.

Stared!

Originally posted by boymonkey74
reply to post by FlyersFan

 

Question (BTW I completely agree with you)
What is stopping our governments bringing in laws that would help people who want to be assisted in their passing?
I suspect it is religion but I would like to hear your thoughts.

It is for a large part religion, but it is also our culture in general.

But the times they are a changin'!
See my post above. Belgium is at the forefront in this issue. It is amazing to see how quickly people adjust to a new way of thinking about dying.

soulwaxer

reply to post by soulwaxer


We had a test case in which a man who couldn't move at all wanted to die and unfortunatly he lost the case so people still have to suffer here in the UK.
Good to know other countrys are getting it right though.

Originally posted by boymonkey74
Just to point out Nurses are amazing people they deal with stuff I nor many here could not.
Instead of listening to armchair nurses why not listen to the people who do the job eh~?

My gran died over Christmas and the nurses and medical team were amazing. They work so hard. In at 7am till 9pm. Remaining caring and thoughtful the whole time. My gran was put on the LCP, but it wasn't a cruel thing to do. They could have put her on a respirator to keep her going, but that would of meant she would have died from blood poisoning. They literally tried to do everything to keep an 86 year old chain smoker alive.

It may sound callous, but when the dying process has begun, a lethal dose of morphine would be the most humane way to go. Look at how people treat their pets, they don't expect every piece of medical technology to be used to keep their dog or cat alive. They let their animals go with as little pain as possible. I know when I'm going and there is no way back, I don't want to be forced to stay alive just to appease the armchair nurses.

reply to post by FlyersFan


I was just about to post the soylent green death scene clip. I like the idea apart from the obvious ( wont do a spoiler). It would be a great idea, you could have friends and family, maybe have a little party. You could then have your choice of departure based on when your ready, not when the medical profession is ready.

I keep thinking about something Alan Watts mentions about going out with a bang rather than a whimper.