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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 willingl

by 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.

by tekla 1y ago

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.