4 ms·

Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that oth

by tekla 1y ago

Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that others deserve to have their demands met about procedures in the face of rational argument. My parents have a DNR because they are both doctors and have spent too much time forcibly keeping people alive-ish because they were ordered to keep people on the edge of death alive, consuming incredible amounts of money, manpower, probable pain, and medication to keep someone barely alive for a week or two. So many people are kept alive in arguably incredibly painful and shitty situations because of the inability to deal with the fact that sometimes people die

UncleMeat 1y ago
DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.
- tekla 1y ago
  It is HARD to figure out if someone actually knows what a DNR entails if they do not know what it actually requires. Everyone can easily make a choice willingly to not file a DNR if they do not know what that requires. So now your grandmother is getting is a intubation tube shoved down their throat, chest compressions, and whatever and is not a state to figure out "wow this fucking sucks" anymore, also someone just collapsed your rib-cage giving you chest compressions. Keep you alive at all costs is easy to agree to if you have no fucking clue what "all costs" mans
  - hedora 1y ago
    So, assuming I own some stock in your insurance company, it'd be ethical for me to register a DNR for you without your knowledge, then pay anyone that's supposed to transfer you to a hospital to not do it? That's exactly the behavior you're defending.
    - jxjnskkzxxhx 1y ago
      I suspect that in our society the answer is: if that's done on an individual basis, it's criminal, if it's done as a matter of policy and you can argue it's beneficial for shareholders, then it's encouraged.
  - Teever 1y ago
    This is all true but this is all misdirection from the topic at hand which is that a man organization with a profit motive may have coerced health practitioners into forcing DNRs into people.
  - mindslight 1y ago
    Discussing ahead of time whether a patient wants specific medical interventions performed or not is squarely in the domain of geriatric medicine. Health Care Proxies can sign DNRs as well, so this argument is completely unfounded. Your implicit argument is that if the patient doesn't sign a DNR, and their family/HCP doesn't sign a DNR, that it is ethical for the medical system to do it anyway on their behalf. If you want to make that argument explicitly, go right ahead. But it's going to get rejected out of hand in a thread about the healthcare industry making such decisions out of expedience, and rightfully so.
  - FireBeyond 1y ago
    It's really not. You don't just pick up a POLST form at the grocery store. You have to get one from your doctor and go through it together. https://doh.wa.gov/public-health-provider-resources/emergency-medical-services-ems-systems/portable-orders-life-sustaining-treatment-polst https://doh.wa.gov/public-health-provider-resources/emergenc... is the one in my state and it is very clear about exactly the things you mention. Full treatment is described as: "Primary goal is prolonging life by ALL medically effective means. Use of intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Includes care described below. Transfer to hospital if indicated. Includes intensive care." The care described below includes "IV medication access", "invasive airway management". It even includes "assisted nutrition", i.e. feeding tubes or ports. It also requires a demonstration of comprehension of these choices by the patient, not just the HCP. > someone just collapsed your rib-cage giving you chest compressions. Frankly, while not pleasant, most people who walk out of a hospital post-arrest have recovered from this in days, and it is generally not particularly painful (because contrary to popular belief, you almost certainly haven't broken ribs, just separated some of the sternal cartilage around the xiphoid process - the little notch midline at your lowest non-floating ribs). There are far more important concerns.
  - UncleMeat 1y ago
    Again, who cares in this circumstance? "More people should have DNRs based on the actual reality of these treatments" could be a fine belief system but that's just simply not what is happening here.
FireBeyond 1y ago
I work(ed) in EMS. I have clearly expressed wishes on a POLST form (Physician Orders for Life Sustaining Treatment, essentially DNR 2.0, with a lot more nuance, like tube feeding, pain management, supplemental oxygen. Actual DNRs are largely extinct). I entirely agree with your parents about the level of effort, not to mention the unpleasantness, pain and suffering associated with fighting off a natural death. But in the context of this article, we are specifically talking about the patients themselves, having coherently expressed a wish to be resuscitated were being pressured into signing DNR paperwork. That's not the same thing as your situation, and I say that as someone who has had to coach hundreds of family members through end of life events, both expected and unexpected. I have done things like ordering continuing CPR on a patient who had no survival outcome expected, just because he was still minimally responsive and his spouse was almost there to say goodbye (he was bleeding internally and could not be stabilized for surgery). She got to squeeze his hand, and feel him squeeze hers back before we discontinued resuscitation and allowed him to pass. And I have done things like brought the "head of the family" into the resuscitation bay because he and the family were adamant in the face of all reality that "God was going to pull their father through" the cardiac arrest he was in. Though painful, it took him but a few minutes to grasp the reality, that all stops had been pulled out, but that we were at the end of the road. Following that, he was able to understand, ask us to discontinue, and be able to go back to the family and explain.

by tekla 1y ago

UncleMeat 1y ago

DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.

tekla 1y ago
It is HARD to figure out if someone actually knows what a DNR entails if they do not know what it actually requires. Everyone can easily make a choice willingly to not file a DNR if they do not know what that requires. So now your grandmother is getting is a intubation tube shoved down their throat, chest compressions, and whatever and is not a state to figure out "wow this fucking sucks" anymore, also someone just collapsed your rib-cage giving you chest compressions. Keep you alive at all costs is easy to agree to if you have no fucking clue what "all costs" mans
- hedora 1y ago
  So, assuming I own some stock in your insurance company, it'd be ethical for me to register a DNR for you without your knowledge, then pay anyone that's supposed to transfer you to a hospital to not do it? That's exactly the behavior you're defending.
  - jxjnskkzxxhx 1y ago
    I suspect that in our society the answer is: if that's done on an individual basis, it's criminal, if it's done as a matter of policy and you can argue it's beneficial for shareholders, then it's encouraged.
- Teever 1y ago
  This is all true but this is all misdirection from the topic at hand which is that a man organization with a profit motive may have coerced health practitioners into forcing DNRs into people.
- mindslight 1y ago
  Discussing ahead of time whether a patient wants specific medical interventions performed or not is squarely in the domain of geriatric medicine. Health Care Proxies can sign DNRs as well, so this argument is completely unfounded. Your implicit argument is that if the patient doesn't sign a DNR, and their family/HCP doesn't sign a DNR, that it is ethical for the medical system to do it anyway on their behalf. If you want to make that argument explicitly, go right ahead. But it's going to get rejected out of hand in a thread about the healthcare industry making such decisions out of expedience, and rightfully so.
- FireBeyond 1y ago
  It's really not. You don't just pick up a POLST form at the grocery store. You have to get one from your doctor and go through it together. https://doh.wa.gov/public-health-provider-resources/emergency-medical-services-ems-systems/portable-orders-life-sustaining-treatment-polst https://doh.wa.gov/public-health-provider-resources/emergenc... is the one in my state and it is very clear about exactly the things you mention. Full treatment is described as: "Primary goal is prolonging life by ALL medically effective means. Use of intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Includes care described below. Transfer to hospital if indicated. Includes intensive care." The care described below includes "IV medication access", "invasive airway management". It even includes "assisted nutrition", i.e. feeding tubes or ports. It also requires a demonstration of comprehension of these choices by the patient, not just the HCP. > someone just collapsed your rib-cage giving you chest compressions. Frankly, while not pleasant, most people who walk out of a hospital post-arrest have recovered from this in days, and it is generally not particularly painful (because contrary to popular belief, you almost certainly haven't broken ribs, just separated some of the sternal cartilage around the xiphoid process - the little notch midline at your lowest non-floating ribs). There are far more important concerns.
- UncleMeat 1y ago
  Again, who cares in this circumstance? "More people should have DNRs based on the actual reality of these treatments" could be a fine belief system but that's just simply not what is happening here.

FireBeyond 1y ago

I work(ed) in EMS. I have clearly expressed wishes on a POLST form (Physician Orders for Life Sustaining Treatment, essentially DNR 2.0, with a lot more nuance, like tube feeding, pain management, supplemental oxygen. Actual DNRs are largely extinct). I entirely agree with your parents about the level of effort, not to mention the unpleasantness, pain and suffering associated with fighting off a natural death. But in the context of this article, we are specifically talking about the patients themselves, having coherently expressed a wish to be resuscitated were being pressured into signing DNR paperwork. That's not the same thing as your situation, and I say that as someone who has had to coach hundreds of family members through end of life events, both expected and unexpected. I have done things like ordering continuing CPR on a patient who had no survival outcome expected, just because he was still minimally responsive and his spouse was almost there to say goodbye (he was bleeding internally and could not be stabilized for surgery). She got to squeeze his hand, and feel him squeeze hers back before we discontinued resuscitation and allowed him to pass. And I have done things like brought the "head of the family" into the resuscitation bay because he and the family were adamant in the face of all reality that "God was going to pull their father through" the cardiac arrest he was in. Though painful, it took him but a few minutes to grasp the reality, that all stops had been pulled out, but that we were at the end of the road. Following that, he was able to understand, ask us to discontinue, and be able to go back to the family and explain.