When you rescind their clearly stated DNR, you are failing them in their last living moments. I see this all the time. And it's just plain sad.
Your grandfather wanted to die a peaceful, dignified death. Because of you he will linger in the ICU for a few weeks before he ultimately dies of something unpleasant, painful, and expensive. There is almost nothing worse you can do to someone than to remove whatever control they tried to exert over their own inevitable death. You have ruined the last few weeks of his life, and that is an awful thing to do to another human being.
6 Outbursts:
Hi Happy - I was on the other side of that DNR in April... as I watched my mothers BP slowly drop as she lay there motionless in the ED, while intubated. (Died of a GI bleed/Sepsis/cardiac arrest - she was 85)Her bp was so low that they couldn't give her pain meds, but at least she wasn't agitated and seemed beyond discomfort.
Actually,the upside is that she lived independently in her own apartment until last Oct.,85 yrs,4 mos and so I know that is a good long life... more than many have.
But... she was beginning to fall at home, had the start of dementia, which exacerbated while in nursing home rehab and she was never able to leave because from that point she lost her ability to do things she enjoyed(read, puzzles, music, use a remote and then walk or articulate that she wanted to use the phone etc.)It was a night and day difference and apparent she was declining in health and becoming more frail by the day.
Her quality of life had certainly diminished in the 6 months she was there.
I worked in a hospital and regularly handed out the advanced directives and explained their purpose to both patients and families. I agree with doing that..although I haven't done one for myself as yet.
I wrote all that to say this... it is one thing to be on the medical side of it all where everything seems so logical, black and white and right.
But...it is *entirely different*..at least it was for me...when you love the person dying before your eyes and you are feeling desperate and afraid... and your mind starts reeling..wondering if the staff did this, do they know that, what if, what if, what if???...and all the while..you know...your eyes are giving you the truth..all your senses know where it is all going ... and you wish you had more time and if only we could say this do that and you just aren't ready to let go...even though in both mind and heart..you know it is the right thing to do.
Happy... maybe I was wrong, maybe I was selfish... but I was glad her DNR got botched and she didn't have one or she would have died that night in the nursing home. The ED staff couldn't reach her doctor who had a copy and so they were looking to me for decisions.
I couldn't see the forest for the trees. At one point I went out to ask if they got her doc yet but they still couldn't reach him. Knowing they wanted me to make a decision and even tho I had been around this stuff on the medical side...through tears I apologized and said I just couldn't make these decisions because she is my mother and I am too close and I don't want to lose her and I need help with this.
Within minutes...the hospitalist came into mom's room to get me and brought me to the room no one wants to go to when they have a loved one in the ED. This hospitalist was terrific...professional, supportive and compassionate. Thanks to the hospitalist's gentle guidance... I was able to say no heroic measures or anything that would cause more discomfort or pain... but if there was a chance she could survive to assist her.
I knew she was dying...I knew what I should have said, but I was just hoping for a miracle and I know that my emotions were clouding my decision making processes.
She died shortly after I returned to her room.
It is so important to have these things done and accessible before the health crisis occurs.
Still...I am glad I had just a little more time because I kept talking to her, etc because I have heard that the hearing is the last to go.
Goodbyes are never easy... I wish I was stronger and more clear headed, but grateful for both the ED staff and hospitalist helping mom and me through the transition.
I would not have kept her on long term life support. I was just looking to reverse what was going on at that time..signs for life, etc.
It has nothing to do with Happy's ethics, it has to do with the fact that advanced directives are commonly and routinely overruled by aggrieved relatives who can't come to grips with the fact that their loved one is dead, and with what actually occurs in the hospital.
That is one of the reasons I go over it repeatedly with my family. I tell them in person how I feel. I don't want them going against my wishes. It isn't death I'm afraid of, it's the getting there.
No one wants to suffer and languish away.
I'm beginning to suspect your medical ethics, Happy. First the issue of prolonging support of a dead patient, now this. The clearly stated wishes of a patient regarding resuscitation status cannot just be overturned by family members once he/she loses consciousness due to a serious illness. Family members are there to attest to what the patient would want if that was not already known. It is assumed that they would know best. However, if the patient's wishes were clearly stated, the family's input is irrelevant. The doctor that would simply follow the family's wishes in such a case is the one that is "failing the patient". I understand the hesitancy to allow a patient do die in such a circumstance, that is what ethics committees are for. In the few instances this has happened to me, I have obtained a STAT ethics committee meeting to back me up, which they have always done.
That should not be legal. How can it be legal? Imagine if a parent was sitting there saying "I want full care!" and their child said, "No, make him a DNR." That wouldn't fly, this shouldn't either.
IMO, the family should face jail time, and all the staff that were complicit should be fined or temporarily lose their licenses.
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