The DNR decision?

Listen to the doctors and nurses. You can never stop someone from dieing. Eventually we all die and you cannot stop it. Do what is best for Dad. Have them put fluids into his system until he passes away in peace instead of experiencing possibly terrible pains and discomforts in his path to the inevitable. Pray to His creator for advice, He is right their with you.

Vstefans couldnt agree more about the knowledge side of it - I absolutely wanted to know what the arguments for and against were and I could ask questions and they were answered. However, having been a decision maker once, I will never do it again, simply because I am not cut out to make those decisions and to be quite frank, a lot of people aren't ... hence me saying I wont be drawn into an argument on it. In this instance I am quite happy (happy not being the right word but I think you get my drift) to discuss issues with a doctor, and offer my views, which actually would not be helpful since I have had a DNR in place for ME for the last 2 years and an advanced directive, but it is up to the doctor to make the final call - I want nothing to do with that part. My father fought cancer for 6 years and they were the most miserable painful years of his life s bit by bit the cancer spread slowly, very slowly throughout his body....

Wanting to answer Tinyblu....
My personal experiences with ca lung are as follows:
My father wanted to live. He had a lung removed, lived another year until 66. He was able to complete one more tree surgery job.
My mother's husband, with lung Ca, refused even blood transfusions because of his religion, died within 3 months.

tacy, please don;t take this as me being "pro" broken ribs and I am so sorry for what you went through with them, but both my daughter and I have had a couple and it was not by any means the worst pain ever. My metatarsal fracture and a couple ankle sprains hurt worse. I think your mileage may vary and depends on how many ribs and your pain threshold! My daughter was told not even to tape or wrap hers, to reduce the risk of pneumonia by not expanding that area well (but I think she did so she could get back out there as a firefighter), and I do not remember doing much for mine either. To be fair, I think I only cracked a couple, from landing on the edge of an icy concrete sidewalk while walking down a hill at work.

That said, skipping CPR for a very elderly person is not always wrong, epsecially if the occurrence is going to signal a heart just going out completely and not a reversible arrhythmia. For example, if someone had really bad pump failure (cardiomyopathy) and they are not a transplant or implant candidate, CPR would make very little sense; if they had a pacemaker failure it would be different. The chance of survival post CPR in the elderly is low, though not zero, and survival to hospital discharge even lower. You can specify defibrillator and drugs only and you can temporarily lift the DNR if surgery is going to be done.

PheonixDaughter your post is helpful to clarify a point of view, but the problem is way too many docs either think no one's quality of life is worth living unless they are under 65, buff and active, with no disability or chronic medical conditions in sight, OR the other extreme that it is unethical not to just keep everyone here on earth as long as possible no matter what or how. You can get informed on what basic things you say yes or no to might entail, but it is your values and your concern for your loved one's wishes and their autonomy they need form you, not the medical expertise.

Trust me on this. You want to know what a feeding tube, a ventilator, and CPR, do and do not entail and you want the authority to stop chemo, dialysis, or any other burdensome treatment that is not giving any meaningful survival to someone.

We faced this with my MIL; one niece thought a simple feeding tube in the nose meant you had to stay in bed and could not talk..most people do not know that a PEG tube (simple surgical or even interventional radiology procedure) may be perfectly comfortable and people can still eat what then safely can and want to by mouth; it may not make sense to do even that in the setting of advanced dementia, but for someone who can't swallow due to a brainstem stroke or a neuromuscular disease it is often a different story. They are supposed to explain the medical side to you, and you just have to be wary of value judgments or blanket statements that misapply what is true for one group of people to your loved one's specific situation. Sometimes the most important thing you are going to do is to tell and show them what your loved one was able to do before an illness, so they do not assume that an 80 year old grandma who was working in her garden and playing with the grandkids every chance she got was done with living and does not need to get antibiotics if they come down with pneumonia or meningitis.

Yea for cwillie. My Mom is 99 years old. She likes her friends, the food and activities of Personal Care, myself being with her every day (7 x 12hrs), attention from my oldest son who stops over after work, my bringing kitty in to snuggle and nap with her. I have it rough that the Personal Care facility has harmed her for which after each incident I am left nursing her back to health because of their failures, negligence and bad behaviors. Mother has always spaced out bad things happening to her or in the family, even when she was young. She does the same thing now. 100 is the new 70's.

I refused to take POA for healthcare. I will not make a decision and I wont be drawn into an argument on it. I think it is the hardest thing to do and I dont have the specialist knowledge that doctors have nor in this instance do I want it. They get the training ( and if I wanted to be unkind, they also get paid the money) that allows them to make sensible decisions. Therefore as I know nothing I am having nothing to do with it if the time comes.

Jessie, GA, I quite agree with you!

Jessie, unless another family member made a stink about it, I really don't think that there's a lot you can do, but if they were to go after the Dr, who went against the patients wishes, I do believe they Could press charges. Now how unfair is That? As in a time of Crisis, when seconds count, and the mistake is made to "do no harm", how could someone actually press charges, for trying to save someone's life?

It's a terrible catch-22, if you ask me! It does happen thou! Imagine being the long lost Son, who hasn't seen nor been involved in their Old aged Mother's care, for donkeys years, then he presses charges against a Dr? Imagine the Judge that has to hear That Case?!!! But they win, and that is why Malpractice insurance is so insanely costly!

Jessie makes good points about the qualify of life. If it was poor prior to a cardiac arrest, is it going to be just as poor or worse if revival is possible? And would the condition that caused it still be a problem, or could it be corrected to avoid a repeat crash?

Then there's the rib cracking that, from what I understand will likely occur. I've never had cracked ribs but I'm guessing it would be very painful. Add that to the other existing conditions, and I think anyone with multiple comorbidities might be worse off afterwards.

I'm certainly not against CPR; I just think that at some point, keeping someone alive for a questionable if not poor quality of life isn't favorable to the patient.

I know if it were me and I had multiple co-morbidities and a poor quality of life, I wouldn't want to prolong that.

Jessie, I think the sticking point is in who decides what a poor QOL is, and who decides what is "too old"? Not very long ago hip replacements and heart procedures would not have been attempted on anyone over 80, now that so many are living into their 90's and beyond it seems commonplace for the very elderly to be offered such treatments.

I have an ethical question about restarting the heart of an elderly person. If the person had a poor quality life should the heart be restarted? or is it Nature's way of saying enough. Even if we could get the heart beating again, should we? Say the person is more than 90 and has several serious maladies, should CPR/defib be attempted if there is no DNR order in place? If the medical proxy says not to do CPR, what could be the legal implications if the family does not support the decision?

I googled "gentle CPR on the elderly", and came up with nothing. CPR's main function is to get blood flow to the brain of the patient during Cardiac Arrest , and if its not started within 3-6 minutes, then the patient Will suffer brain damage from lack of Oxygen. From everything that I read and have witnessed (I personally have never had to perform CPR, but have witnessed it being done several times), CPR is brutal and normally does break ribs, especially on the elderly, but the whole intent on starting CPR is to buy time until paramedics arrive with the defibrillator, as CPR itself, rarely Re-starts the heart or saves lives on its own. Broken ribs should be the Last thing you are thinking about, if your whole intention is to resuscitate, and start the heart to pumping on its own again. Ribs heal, brain damage is forever.

Personally, I think that a Cardiac Arrest at age 100+, is Gods way of saying that their frail body has had enough, and that we should let them go naturally. We can't keep them alive forever.

I have witnessed a situation with a 53 year old patient, who had a sudden Pulmonary Embolism, and even though aggressive CPR was done immediately, and paramedics arrived within 3 minutes, the EKG, and Defibrillator pads were attached, that the Defibrillators are so advanced and Safisticated, that the monitor "Speak out loud", to "Defibrilate", or "Do Not Defibrilate", as ther are instances where Shocking will not work, or is ill advised. DEFIBRILLATION does not always work either.

Its best to have a clear cut plan of action, Before you are faced with this situation. Decisions under stress and duress, are a bad idea.

Interesting points. What does happen when a heart is resuscitated. Can elderly person be resuscitated in a gentle manner without breaking the breast bone? Are there instances when an elderly person has had their heart stop and then been revived without the unacceptable pain and suffering. Medicine is progressing faster than our perceptions change. I thought all hope was lost with mother's deterioration of her Glaucoma ((eyes) due to failure of Personal Care to properly administer her eye drops). To our surprise we found out that severe Glaucoma can be treated with a non-invasive laser procedure. Had we not kept searching we would not have found this out. Mother's eye Dr. and the specialist he sent us to did not offer this treatment. We has to research on the internet. I will do this re DNR. Also, our Caregivers Support Group is meeting this week. I'll ask about this topic there. Any other thoughts on this?

Do not wait till the last moment to call in hospice. They can be a great source of support before they enter the final phase. Something as simple as continued weight loss or frequent hospital stays will qualify your loved one. If you don't care for their treatment it is easy to withdraw from the service there is no penalty and you can re enter at any time again with no penalty. Always worth exploring even if you don't feel ready to face end of life decisions.

My mom is DNR she made that decision ap any years ago .. so I respect it i will put her in hospice when the time is appropriate.. I dread that day but it's the right things to do when the time is right ,,,God Bless you I know your pain ,,know you are in my thoughts and prayers

and what would be her quality of life if she is resuscitated after her heart has stopped for some reason... I think it is harder for you since your mother has given you the responsibility for all medical decisions.

Thanks 23. That is a good point. I would like to know more about resuscitation success or failure of the elderly. Can a more gentle push that doesn't break the chest bone be effective?

lu - thanks for the clarification. I question that the nurse can say with certainty that an elderly person's heart can be resuscitated with or without breaking the breast bone. I don't think they can ever be sure that the procedure will be successful. Hope someone here has some experience with this.

dauhterlu - this is a very hard time. The main thing is that the senior's wishes should be honored. It is not what the POA wants for their parent. There may be a difference. My mother, aged 104, made her DNR very clear nearly 10 years ago. Frankly, since she has stated her wishes, I have not even thought about what I would want for her. I know her position. We have updates several times but essentially it is the same The POA acts for the person according to the person's wishes when the person cannot state their own wishes. What does your mother want for herself? ((((((hugs)))))

stacey - you make some very good points. Things can happen very quickly and emotions run high. That's why these documents exist.

I am sorry that I wasn't clearer. Mother made me her POA of Health Care and replaced her Health Care Directive leaving all decisions up to me, leaving all directives with a note that it is up to the POA. We got help from a facilitator of a Caregiver Support Group and Mother's Attorney. We would be without Mother here on earth if her prior Health Care Directive had not been disavowed and replaced giving me POA over all decisions. We can discuss matters as time goes on. I am an obedient daughter and carry out mother's wishes. I did not have to contemplate DNR as her heart did not fail. The nurse advised that the Doctors can revive an elderly persons heart without breaking her chest bone. She said they are gentle with the elderly. has anyone had this experience?

Daughterlu, I hope that you did not misunderstand my suggestion for the care your Mom should receive during a crisis.

I definitely understand your Loving and Cherishing her, as I did my own Mom, God rest her soul. I too take care of my own 87 year old FIL, in my home, and have for the past 13+ years, and I (along with his Son) also am his Healthcare proxy. He and I have had many a discussion about end of life care and crisis care. He has an Advanced Directive which is very specifically completed, and I will abide by his wishes. At any time, should he wish to make changes, that too!

Having worked in Healthcare for 30+ years, including the Cardiac and Pulmonary department, I have seen on many occasions, patients "go down, and go unconscious" and unable to speak for themselves, and this is where those Directives come into play, as there is not a lot of time, sometimes only seconds, between calling 911 and the paramedics arriving, that CPR needs to begin, and checking to see if an Advanced Directive is in place, let alone call around to see if the Medical POA/HEALTHCARE PROXY is available for consultation, to make the crucial decisions to begin Cardio and Pulmonary Resuscitation, is not a viable option, and there could be the possibility that you aren't there with her at the time. Sadley, in some cases CPR was done, when the patient or family would have preffered that it not have been, and long term health issues then come into play. So honestly, "ask me at the time", is not a very smar decision.

I highly recommend that you research THE 5 WISHES. Which addresses Medical, Legal, Spiritual and Personal desires for end od life care, and is clear, consise, and addresses everything that I can think of for Loved ones discussing what is best for them. It also opens up a good family dialog, so that everyone concerned, or involved can understand the desires of the patient. But mainly, these are decisions the patient must make, and we as their Loved ones can abide by them with the confidence that it is what the Wish!

I love that you Love your Mom so very much, to do right by her, no matter how old she is! Age is just a number!

I don't believe Anyone should have a BLANKET Directive, and also believe that Advanced Directives should be discussed and Updated from time to time, as long as the Patient understands the decisions they are making.

My Great Grandfather lived to 106. At 100 he bought a house on a main thoroughfare and had a general store built on to the front that he could run when he was 100 years old. 100 year olds should not be ignored because of their age. Mother has put her faith and trust in me regarding Health Care even though it is in the present tense not when she becomes incompetent. She knows I love and cherish her as head of our family. We have 5 generations. Regarding her eye care, her eye Dr and the specialist didn't want to do anything about her severe glaucoma. We went to a Glaucoma Specialist who does not summarily turn down the elderly. I've seen too many of the elderly not treated for treatable health issues, put to sleep like you would a dog or died and/or mismanagement of their health care I do not want this to happen to Mother. DNR is an easy way out for the facility and family. Each case and family are different and we need acceptance in our society of an elderly person who does not want a blanket DNR.

Dont put him through a surgery or chemo. So awful for seniors with weakened bodies. My dad said same as yours when he was diagnosed with cancer. My mom forced chemo and dad stopped it after about a month after awful side effects. He just walked into room and announced "im done". He passed away at home "his way" with hospice 4 weeks later.

Dont put him thru this. You have many here's support --thise who have been where you are or know the pain and frustration of dealing with surgery that turns into long drawn out tumultuous recovery that sometimes never comes...just multi hospital visits to treat infections, woulnds that wont heal, dehydration, weakness when they cant get back in their feet.

Save you and your dad the heartache.

Daughterlu, I expect that you will be getting varying answers/suggestions on the issues of the DNR, that your Mother signed 15 years ago, and then put in your hands as her POA to follow.

Im my opinion, the Dr wanted to press you on the issue specifically regarding CPR, as they don't always have the time nor resources to find you and discuss whether or not you would wish them to proceed with CPR, and that goes for Anyone, not just your Mom at age 100, and still wanting to live.

IMO, the time when people fill out their Health Care Wishes, is normally a time when they Are of sound mind, are clear thinking, and would want their wishes abided by, even though at the time, it is a Very difficult decision to go along with them.

Our Mom had a very difficult time making those sorts of decisions too, at the end of my Dad's life too, for religious reasons, so I am most certainly not judging you.

Wow, 100 years old! That in itself is an amazing feat, and one not many achieve too often, you should be happy to have had your sweet Mom this long, and also that you come frome a good line of healthy DNA!

In the end, my recommendations to you are to decide on those most urgent decisions that require immediate attention and stick to them, acting as if you were your Mom making them, and if your Mom is still of sound mind, discuss them once again, and update her Advance Directive or 5 Wishes forms, and let them stand, this way, it is taken out of your hands at the time of high emotions. Then, there should be no guilt attached to those very tough decisions during a crisis. It is always tough though!

Mother was recently in the hospital. The Doctor was questioning me regarding Mothers POA of Health Care. It is essentially referring all decisions to POA which is myself. I stated all measures, he asked about resusitation. I said ask me at the time. I wouldn't want to have her ribs broken to resusitate her heart at her age because I hear it is so painful for the patient who is near 100. The Dr. was gruff. He wanted a DNR answer. I stood firm. After he left the Nurse whispered to me. When someone is near 100 they can resuscitate more gently. I would not be quick to say DNR. Also there are elderly patients with older POA health forms who will die from pnemonia if they state no fluids, no antibiotics. I had a tough time handing Mother's POA of Health Care to her facility. It took 6 months until they put the same in their book at the front desk. When Mom got pnemonia (untreated when she was in the Health Care Center when we called 911) Had we not done this Mother would not have survived the ordeal has she had her older Health Care Directive in effect. Pnemonia is very treatable. My cousin, a retired pediatrics Dr. did not support me. His idea that what my Mother decided 15 years ago when she was younger was what she actually wanted as stated when her mind was more alert. My position is times have changed and mother is the figure head of our family and very much loved and cherished. We are blessed, she is not suffering. She is excited by life and wants to live.

God bless, JB.

So sorry, JB. Sending hugs and comfort.

Thanks for your thoughts JB. My condolences to you.

Big hugs, JB. And a "well done" to you for doing the right things right though nothing was easy...!

JB condolances. Your mother raised a strong and loving daughter. May you find peace after the chaos.