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As broken as our system is (and Scott's obvious pain should make it clear that it _is_ broken), there are things you can do to make it suck just a little less.

As broken as our system is (and Scott's obvious pain should make it clear that it _is_ broken), there are things you can do to make it suck just a little less. Please talk to your family and your doctor about your wishes in terms of life-sustaining care. Even in your 20's, in perfect health, please take some time to become informed about what the options are and how you can express what you want done or not done (this may be a DNR, a MOLST, a living will, or any of a myriad of other options depending on where you live). If the decision you come to is anything short of "do absolutely everything possible to prolong my life" then be sure to have that paperwork in a safe and readily accessible place (and let your family members know where it is).

MetaCosm 13y ago
Also, the more extreme it is, the more you need a lawyer to verify it will hold up. For example, denial of food and water is considered "extreme", if you want that in your paperwork... have a lawyer do a double check.
jlgaddis 13y ago
Recently, I dated a nurse who worked on the cardiac floor of the hospital. She had patients who died every day. One day, the subject of DNRs came up. Interestingly, she mentioned that "they're meaningless". When I asked her about it, she said that if, for example, I had a DNR but an immediately family member told them to "save me", they would disregard the DNR and do it. The reasoning, she told me, was that regardless of what they did (save you versus letting you die) there was a chance of a lawsuit and that the hospital would rather be sued for saving your life. (I'm sure it isn't this way everywhere.)
- JshWright 13y ago
  I'm in a similar position on a fairly regular basis, and I can tall you that DNRs absolutely do matter. It would take the threat of physical violence to get me to perform ACLS on someone with a valid DNR (this is in a prehospital EMS setting). A DNR represents the expressed wishes of the patient. Disregarding that is a serious breach of medical this. I'm not sure how often she came across that particular dilemma. As a nurse in an ICU she would have limited decision making authority when it comes to initiating and continuing things like ACLS[1]. That's a doctor's call. I will say that in my experience as a prehospital EMS provider, I absolutely honor the wishes of the patient (as expressed in a DNR) over the demands of the family. In fact, in my experience, the issue that arises is exactly the opposite. The family doesn't want CPR, etc, and states the patient has a DNR, but they're unable to produce it (hence my original post). In the absence of a valid DNR, I have to assume the person _does_ want all resuscitation measures attempted. [1] http://en.wikipedia.org/wiki/Advanced_cardiac_life_support http://en.wikipedia.org/wiki/Advanced_cardiac_life_support
  - gohrt 13y ago
    As a pre-hospital EMS provider, how do you have time to determine the presence and validity of a DNR before making your choice?
    - JshWright 13y ago
      It's pretty simple... is there a DNR in my hand that hasn't expired and has been signed by both the patient and a doctor and hasn't expired? If yes, then don't initiate resuscitation. Obviously a DNR could be forged, but baring obvious cases of forgery (which I've never seen), we're not liable for honoring a DNR that we reasonably believe is valid.
      - jlgaddis 13y ago
        What about a "verbal DNR"? I was recently involved in a pretty bad motorcycle accident and was asked multiple times (by EMS on the scene, medical staff in the ER, medical staff right before going into the OR, etc.) if I had a DNR and/or if I would want them to attempt to save me if something happened. I remember thinking that was kinda weird since my assumption was that such requests would need to be in writing. Perhaps it was because I was incapable of writing or signing my name, though (two broken wrists)? Instead of me signing any documents, they just asked me verbally after making sure they had two other employees present as witnesses.
        JshWright 13y ago
        That's actually _better_ than a written document as far as I'm concerned. A DNR basically says "If I'm unable to speak for myself, here's how I would like to be treated." If you _are_ able to tell me how you want to be treated, then there's no question (assuming I'm confident in your ability to make informed decisions... not drunk off your ass... etc...)
    - FireBeyond 13y ago
      In addition to what Josh says, in ambiguous situations, we will begin CPR or other life-saving measures whilst efforts are made to obtain/ascertain. We can always discontinue these efforts - on the other hand, delayed starts of such measures are more likely (if they result in survival at all) to end up with exactly the kinds of situations described here, brain damage, serious side effects, and the like.
- gohrt 13y ago
  Sure, but that reasoning applies in an emergency. After the emergency, once the patient stabilizes (perhaps unconscious), the paperwork can be reviewed carefully and a final decision made.

MetaCosm 13y ago

Also, the more extreme it is, the more you need a lawyer to verify it will hold up. For example, denial of food and water is considered "extreme", if you want that in your paperwork... have a lawyer do a double check.

jlgaddis 13y ago

Recently, I dated a nurse who worked on the cardiac floor of the hospital. She had patients who died every day. One day, the subject of DNRs came up. Interestingly, she mentioned that "they're meaningless". When I asked her about it, she said that if, for example, I had a DNR but an immediately family member told them to "save me", they would disregard the DNR and do it. The reasoning, she told me, was that regardless of what they did (save you versus letting you die) there was a chance of a lawsuit and that the hospital would rather be sued for saving your life. (I'm sure it isn't this way everywhere.)

JshWright 13y ago
I'm in a similar position on a fairly regular basis, and I can tall you that DNRs absolutely do matter. It would take the threat of physical violence to get me to perform ACLS on someone with a valid DNR (this is in a prehospital EMS setting). A DNR represents the expressed wishes of the patient. Disregarding that is a serious breach of medical this. I'm not sure how often she came across that particular dilemma. As a nurse in an ICU she would have limited decision making authority when it comes to initiating and continuing things like ACLS[1]. That's a doctor's call. I will say that in my experience as a prehospital EMS provider, I absolutely honor the wishes of the patient (as expressed in a DNR) over the demands of the family. In fact, in my experience, the issue that arises is exactly the opposite. The family doesn't want CPR, etc, and states the patient has a DNR, but they're unable to produce it (hence my original post). In the absence of a valid DNR, I have to assume the person _does_ want all resuscitation measures attempted. [1] http://en.wikipedia.org/wiki/Advanced_cardiac_life_support http://en.wikipedia.org/wiki/Advanced_cardiac_life_support
- gohrt 13y ago
  As a pre-hospital EMS provider, how do you have time to determine the presence and validity of a DNR before making your choice?
  - JshWright 13y ago
    It's pretty simple... is there a DNR in my hand that hasn't expired and has been signed by both the patient and a doctor and hasn't expired? If yes, then don't initiate resuscitation. Obviously a DNR could be forged, but baring obvious cases of forgery (which I've never seen), we're not liable for honoring a DNR that we reasonably believe is valid.
    - jlgaddis 13y ago
      What about a "verbal DNR"? I was recently involved in a pretty bad motorcycle accident and was asked multiple times (by EMS on the scene, medical staff in the ER, medical staff right before going into the OR, etc.) if I had a DNR and/or if I would want them to attempt to save me if something happened. I remember thinking that was kinda weird since my assumption was that such requests would need to be in writing. Perhaps it was because I was incapable of writing or signing my name, though (two broken wrists)? Instead of me signing any documents, they just asked me verbally after making sure they had two other employees present as witnesses.
      - JshWright 13y ago
        That's actually _better_ than a written document as far as I'm concerned. A DNR basically says "If I'm unable to speak for myself, here's how I would like to be treated." If you _are_ able to tell me how you want to be treated, then there's no question (assuming I'm confident in your ability to make informed decisions... not drunk off your ass... etc...)
  - FireBeyond 13y ago
    In addition to what Josh says, in ambiguous situations, we will begin CPR or other life-saving measures whilst efforts are made to obtain/ascertain. We can always discontinue these efforts - on the other hand, delayed starts of such measures are more likely (if they result in survival at all) to end up with exactly the kinds of situations described here, brain damage, serious side effects, and the like.
gohrt 13y ago
Sure, but that reasoning applies in an emergency. After the emergency, once the patient stabilizes (perhaps unconscious), the paperwork can be reviewed carefully and a final decision made.