Saturday, January 23, 2010

If a person is terminally ill, would you agree to a NO RESUSCITATION policy with Hospital Staff ?

Imagine a 82 year old person is terminally ill, there is a chance of hospitalisation due to a chest infection, the person might go into shock, NOT due to the terminal illness. On hospitalisation you are asked, if staff should resus or not. What would be your decision?If a person is terminally ill, would you agree to a NO RESUSCITATION policy with Hospital Staff ?
I'm a newly qualified doctor and I've just worked a week of night shifts, during which time I had my first attempt at resuscitation. This woman was 82 and had undergone a major operation. She deteriorated throughout the course of the night and went into cardiorespiratory arrest. Resuscitation was attempted, but failed. And you know what, it was horrible. I though it was so undignified, such a horrible way to go. Instead of letting her just slip quietly away, which I've seen so many times, they were jumping up and own on her chest, pumping her full of different drugs, and in the end it didn't work anyway, they left her lying in the midst of rubbish to die. Instead, she could have slipped quietly away with her family by her side.

This patient you talk about is 82 and terminally ill. They don't have much life left, and probably the quality of life right now is poor. You always have to consider the fact that resuscitation isn't actually all that effective - not in old, ill patients with many other health problems. How would you rather this patient died? Slipping away peacefully in their sleep, or the way I've described above?

That's just my personal opinion. It's your decision. But that's how I feel about it.If a person is terminally ill, would you agree to a NO RESUSCITATION policy with Hospital Staff ?
This is a good question and it reveals the reason you must make your wishes known while you are still healthy enough to make them.

It is hard to watch someone you love die but everyone needs to be realistic.

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Usually it is the child with the worst relationship with the parent who won't let go and fights everyone else to ';make'; the parent live...sadly they have the worst grief because they were selfish jerks when the person was alive. Sorry to say this but I've seen it over and over.

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have medical power of attorneys drawn up %26amp; let the people closest to you know your wishes.

It was hard to not act when my father in law was dying but he had made his wishes known %26amp; a feeding tube would have just extended his agony by hours or a day or two.

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I personally would not want to play God. Once you start to allow something like this you are in grave danger of opening flood gates to assisted killings euthanasia, assisted suicides.
Am I in the will?
It shouldn't be my (or your) decision. It should be something the patient themselves have already decided upon. Otherwise, there is no decision to make - you must resuscitate.

If the patient is incapable of making such a decision, due to dementia, NOT this recent acute illness, then the family as a group should decide, based only on what the patient indicated before dementia set in.

If no such indication of a DNR exists, then you should not take it upon yourself to make that decision. It is not your decision to make.
I am a nurse and having seen how people suffer in that state personal wishes are for a NO Resuscitation order for myself if I am ever in that state. All it does is draw out the person's suffering and rob their estate of money by creating more medical bills. That's my opinion as I have watched many dying people. The decision has to be yours though and if the family member you are speaking for is alert and oriented you should consult them or think about what they may have told you about their wishes when they were still able (if they are not alert and oriented). In any case a terminal illness is day you will not be able to revive them and the illness will take them anyway is just more suffering for them to experience.
do not resuscitate, usually someone who is terminally ill is in pain. If you resuscitate, you bring them back to suffer more. I believe that if you really love this person, you will think of what they want and need, not your own wants and needs. I know if I were terminally ill, I would not want to be resuscitated.
Not to resusitate! I had to make the decision when my mother was in hospital during what turned out to be her last illness. It broke my heart to do it but I knew that to insist on resus would have been against her wishes and no favour to her in the long run.
Personally I don't think I even want to live to be 82, you can't drive well, you're in a lot of pain, you have to use a diaper, someone else has to change your diaper... if the person was 22 with no possibility of brain damage I'd do it but at 82 they're close enough as is.
No I really dont think it would be fair on the patient to be resusitated if they are terminally ill as they would continue to suffer. Kinder in the long run to let them go so as not to prolong the suffering. Sorry............
i would agree with the no recuscitation, especially given the persons age and the fact they are terminally ill. sometimes its kinder to let them go. it would only be for selfish reasons to have them brought back only to have them suffer. my grandpa was 74 with a clot on his brain which caused him to have many strokes. my gran decided on a n/r cos he was in so much pain. it wasnt an easy decision for her but if you love someone you would want them to be painfree.
If there is no hope for them to live a happy, healthy life, it is time to let them go.
That decision needs to be made by that person or someone acting on their behalf if they are not able to make that decision. I would ask the person what their wishes are before going into the hospital. Let them know that no resuscitation (DNR) does not mean that if they are choking on food that nothing would be done. If they would choke, they would have the proper things done to try and stop them from choking. I'm not quite sure what you mean by shock. Do you mean that they might have a heart attack or go into cardiac arrest? What disease do they have? There are a lot of factors. Again, I would ask what they wanted and stand by their decision. There are a lot of people that are terminally ill that actually die from something else. For example, I take care of many people with cancer, and what actually kills them is usually a heart attack or something like that. They need to decide if they want to be treated.
Ok so this person has a terminal illness, which is not treatable, but with medical care their life has been made comfortable and their life may have been prolonged through medical intervention.

So now this person has a complication..they have become sick with a treatable illness.

Right I Understand鈥ou want to know if you should instruct the medics to withhold any further treatment鈥︹€檔ow鈥? because this person cannot make any decisions for themselves at this time!

I would say rescusitate..because then you have at least given some value to the life of this 82 year old human being who has battled to stay alive this long.

Give them a chance.
That decision is, fortunately, left up to each individual (i.e., to each 82-year-old terminally ill person), rather than to hospital staff, or anyone else, for that matter.

Hospital staff have an obligation to resuscitate. That is their job. It's no one else's business.
Do Not Resuscitate.

Ultimately, the decision should be made by the patient first of all. They need a full explanation of what the situation is and what you are asking before makeing a decision.

If they are unconcious and unable to make the decision. the imediate family needs to make the decision. I'd say Do No Resuscitate.
Depends on the situation. If the person was given less than six months to live, was suffering horribly, and the person didn't want to be revived then yes I would agree to a DNR. If there is no hope for a remission, pain medication is not working, you know at 82 the person has lived a long life. Sometimes even much younger patients want DNR due to pain and no chance for remission. I agree it is a hard choice to make but sometimes the decision does fall on a younger family member. You could talk it over with the doctor or your minister if you are having a hard time with the decision. Good luck
By agreeing to a ';DNR'; you are not condemning them to a death sentence in their current ill-health - full treatment would still go ahead - what you have to ask yourself is, how ill would that person already be if they reached the point of cardiac arrest, would resuscitating them bring them back to good health, how likely is this given current illness and their age - are they likely to continue life but only with further sickness and suffering? and if they were resuscitated - do you think they would have wanted this? That being said, it is common practise for doctors to ask this question now, medical advances mean they can keep anybody 'going', but doctors recognise that this might not necessarily be right - or wanted! Hope this helps! And remember whatever you decide, you are not doing this alone - the ultimate responsibility lies with the medical team.
as bad as this is my friend started university in septembershe now has 6 wks on the ward,then 6 wks back at university,she said that on the notes of the elderly they have do not resuscitate,make sure that u r with that person so u can care for them eg,dinner times , they seem to ignore the elderly,this is only myopion ,with my nan she was terminally ill but had to be addmitted but our family made sure that she had 1 of us their throughout the day, we used to sponge her lips ,she was allowed home but wasn with us long after due to her terminall illness , not sure if i could agree with that though
you need to get the patients view while they are lucid but in a you gotta answer now situation i would look at the quality of life my father was ill he had had a few strokes could not do anything for himself let alone comunicate he had more wrong than right when asked i said yes to the dnr as i could not watch my always active funloving father just lie there turning slowly into a vegitative state but i will say although i said yes it was a hard decision i had to be sure i was doing what i thought was right for him and not what might be easier for me my father did pull through that night but died a few days later
i would not resusciatat because of the age and the illness and because she is incohearnt anyway. what kind of life would she have if saved anyway. i know living with a chronic heart condition i rather go than have someone pounding on my chest because it does not feel good to be sick all the time while alive.
The hospital can only enforce a DNR (Do not recessiatate) if you have signed a paper to that effect. Other than that, they have to do all measures to keep that person from dying.
No resus
let her go in peace
It is not our decision to make. It is the patient's decision.

I would say ask him or her and if they can't make this decision then it is a clinical decision.

To the added comment:

They are not asking us whether you want him/her to die or live the question is- Is he/she likely to survive resuscitation and is it in her/his best interest? how would i know that?

I would say please act in his/her best interest.
If they have a chest infection it may develop into pneumonia this used to be called the old mans friend in medical circles,as long as the patient is not in pain and comfortable from personal preference if it was me I would say let nature take its course with no resuscitation,if this person is real,God Bless and keep them.Just to clarify I meant if the patient was me,as others here have said,The patient or relatives must make their wishes clear so as not to compromise the medical staff
To not resus.

That is what I would want.
if i could stay alife y not!

if i could make another alife y not!
If they got no quality of life and they terminally ill then yes I agree let them go
if you are asking for advice as you are about to make a massive choice, then please make it yourself xxx

BUT if it were me or my wife to be %26amp; i love her beyond words!!

If she was being eaten alive i would END it FOR her comw what may.

Because i,d not want to live if she,d passed away SO no court on this Earth could imprision me, as i,d go too
resus them still
That is a decision that must be made by the patient only, if they are able to make the decision. If he/she is unresponsive or mentally compromised at the time of admission, then the closest family member or the one who has his/her medical power of attorney will make that decision. The best thing to do, if the person is of sound mind, is to have them make this decision and the decision of specific instructions to implement when they are determined to be beyond surviving, by making an Advanced Directive or Living Will now. Then the decision is taken out of your hands. An attorney can do this or there are forms at the hospital and Drs. office the person can fill out. They MUST be signed before a notary and witnesses.

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