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Make sure the elderly and those within the dying process understand the options and consequences of a DNR (Do Not Resuscitate) option.

A large number of elderly people in the dying process choose to invoke a DNR clause with their healthcare but the consequences can be awful.

Photo of Kathi
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My parents decided many years ago to choose the DNR (Do Not Resuscitate) option with their healthcare.  However, they were not told that their healthcare provider/insurance had different versions of the DNR option available to them.  My parents, I'm sure like most elderly people, believed this would just be involved with "no intubating" should they stop breathing.  No long term respirators or other devices that keep the body alive while the person is in reality gone from the body.  However, as we learned the most painful fact of a DNR can also include "no invasive procedures such as an intravenous feeding tube".  My father collapsed with congestive heart failure and ended up in a hospital on oxygen 24/7 with fluid in his lungs.  But because his DNR with this organization specified "no invasive procedures" they refused to feed my father at all.  Because he was on oxygen, he was not given oral nutrition because the doctor claimed he would vomit.  This same doctor refused to give intravenous nutrition claiming the risk of infection were too high.  Even after I printed out articles totally supporting intravenous nutrition outweighed any infection risk - he refused to comply with our request.....because of the DNR my father had signed.    My father was in this hospital for 5 days before being transferred to a post acute facility.  During these 5 days he cried for food and at times became irrational with the lack of nutrition.   Everyone involved with his care at this hospital refused to listen to family or consider options just because of the DNR that was in place.  There was only pain and no acceptable dignity or quality of life given to my father!  I have since urged my mother to revoke her DNR status.   

What is a provocation or insight that might inspire others during this challenge?

The challenge is how to really give dignity and comfort and quality to those in the last phases of dying. When these bodies are tired and the words just don't come out.

Tell us about your work experience:

I work in the pathology field and have been here for 15 years. While I do not have direct patient care in a healthcare facility, I do (or did) have direct of my parents.

If you participated in an End of Life Storytelling Event, tell us which Chapter or city you came from:

Sutter Health - Sutter Solano Medical Center

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Photo of Jim Rosenberg

I can't imagine how hard that experience was for you and your family. When Amy, my wife, was ill we found questions around DNRs to be incredibly difficult to sort through. First we had to deal with our emotions in facing Amy's death and trying to talk about her last moments. Then we had to deal with the technical complexities (what is covered, in what situations...). Then we had to understand the difference between the effectiveness and harm of extraordinary measures in real life versus what we see on TV hospital dramas. And *then* we had to understand what her death was likely to look like and whether extraordinary measures in her case could ever be effective -- that is, could they ever come into play at a point where she had a chance of recovering and living longer. We were lucky in finding a medical student (yup, 23 years old or so) recommended by the oncology nurses who was exceptional at talking through these questions. But how can we change the system to make it easy for people, before or during acute health issues, to make the right decisions about extraordinary measures and DNRs?

Photo of Kathi

EXACTLY!!  Where in the process does this issue get addressed fully?  Should it be up the 'Case Managers' ?   Unfortunately the doctors don't have all the answers and by the time the hospice nurses come there's not enough time.  Thank you for your response!