[ExI] Signing your death warrant

SR Ballard sen.otaku at gmail.com
Sun Jun 7 17:59:34 UTC 2020


Why can’t we have a separate classification of like... “Limited Resuscitation” Orders? If they are a thing, I’ve never heard of them.

And I have to admit, people are really not that knowledgeable about their own healthcare options and it’s very sad.

On the other hand, I have family experience with doctors just straight up ignoring DNRs that they are painfully aware of, for both my aunt and grandmother.

(Neither of them appreciated that, by the way. My aunt has a pain disorder and they did chest compressions on her. She lives in... basically agony everyday because of it.)

Oh well...

SR Ballard

> On Jun 7, 2020, at 5:02 AM, Rafal Smigrodzki via extropy-chat <extropy-chat at lists.extropy.org> wrote:
> 
> Recently the hospital administration, in their wisdom, decreed that I have to ask each and every patient I admit about his preferences regarding resuscitation. Previously I did not do it, the default being full resuscitation, that is doctors making all efforts to restart the patient's heart and breathing should they stop but be potentially recoverable. Now I have been asking the same questions multiple times a day and I am shocked about the answers I hear.
> 
> Let's not discuss much those who say they do want to be resuscitated - aside from mentioning that sometimes people are distressed by having the question posed to them. Do they wonder if I am, well, hesitant to do everything to help them? That I am eager to let them drop dead, if they would give me an excuse? From the way many react I gather they get suspicious and I immediately reassure them that I only ask the question because "they make me do it".
> 
> But very often, when I ask "If your heart stopped, would you like the doctors to help you or not?" they say "No, do not resuscitate, I have the papers, living will, advanced life directives and whatnot", as if they knew what we are talking about. If I stopped questioning right there, the order DNR would be entered on chart. But I always follow up with "So let me make sure we understand each other - if your heart stopped, and we could get it restarted, with an electric shock and medications, and get you back to your normal life, you want the doctors to stand around while you are dying and do nothing? Are you sure?". Nine times out of ten the patient, even the ones with all the papers filled out and signed and validated by lawyers, will say "Well, if you can get me back to normal, help me, I don't want to die, I just don't want to be hooked to a machine and never get off it". 
> 
> There is a common misunderstanding among patients that when they sign their DNR papers they just make sure that their lives would not end in a futile and painful ICU stay, on life support, to be eventually terminated without ever going back to a life worth living. But in fact, DNR means much more - it means no efforts will be made to help them even if their chance of recovery is high. I once had a patient who coded almost ten times, and was resuscitated successfully, usually within less than a minute by one or two defibrillator shots, and walked home none the worse for wear, with a new pacemaker. This situation, a sudden cardiac arrest in the hospital on telemetry (heart monitoring) is completely different from an unmonitored cardiac arrest, or arrest in the course of progressive and irreversible disease. The former has a very good prognosis, as in my patient with ten lives. The latter is what DNR should be about - situations when efforts are often futile and result in wrongful life - short, painful, meaningless survival of the body while the mind is already too far gone, even if not strictly speaking brain dead.
> 
> Unfortunately the DNR papers don't really make a distinction between them, or the distinction is lost on many patients when they talk to their lawyers. How many hundreds of thousands of Americans are admitted to the hospital every day? How many tens of thousands have DNR orders they never really meant to authorize? What if your doctor just takes your "No, no, just let me go" at face value, and marks you for death you don't really want?
> 
> My guess is it happens all the time but nobody pays attention because those who are harmed are all dead and speechless, and the paperwork is ok.
> 
> If a doctor, a lawyer or another huckster asks you if you want to have DNR orders be sure you really know what the story is about. You don't want to sign your own death warrant accidentally, do you?
> 
> Rafal
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