Do Not Resuscitate? - Real ethical decisions

[Occams Barber]

Do Not Resuscitate?

My father is 100 years old. Late last year he was diagnosed with progressive dementia and certified incapable of looking after himself safely. As a result, I placed him into a very nice Aged Care facility. I am now his legal Guardian. Apart from dementia he is fit and well and on no significant medication.


Following a minor medical problem, the care facility realised that I had not given them a Care Plan – basically answers to a range of questions connected to potential end-of-life situations. Among a number of straightforward questions, there are three choices I needed to make which have clear ethical implications. Since my father is considered incapable of making this type of decision I have answered on his behalf.

The choices are:

1.CPR

• I do want CPR if it is medically appropriate
• I do not want CPR at all

2.Life Prolonging Measures (e.g. ventilator, dialysis, feeding tube, surgical intervention)

• I do want to be transferred to acute care for life prolonging measures if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging measures

3. Life Prolonging Medical Support (e.g. antibiotics, fluids and medications)

• I do want to be transferred to acute care for life prolonging medical support if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging medical support

How would you answer? (You can qualify your choices)


Let me be clear that I’m not looking for advice. I’ve already answered. I also answered similar questions a few years ago on behalf of my mother and my kids are aware of my personal wishes on these issues.

OB

 

[Tigger45]

Thank God my parents answered those questions for themselves when they were deemed mentally capable to account for themselves.

 

[Occams Barber]

Thank God my parents answered those questions for themselves when they were deemed mentally capable to account for themselves.

Having been through this twice I absolutely agree. These end-of-life decisions are as important as your Will,
OB

 

[timothyu]

1) do

2) would indicate a serious life threatening situation without a likely good outcome. don't

3) mild to moderate threat do (also prevents then from doing a medically favoured technique with the elderly of withhold food and water while still conscious to hurry the inevitable)

 

[HTacianas]

Do Not Resuscitate?

My father is 100 years old. Late last year he was diagnosed with progressive dementia and certified incapable of looking after himself safely. As a result, I placed him into a very nice Aged Care facility. I am now his legal Guardian. Apart from dementia he is fit and well and on no significant medication.


Following a minor medical problem, the care facility realised that I had not given them a Care Plan – basically answers to a range of questions connected to potential end-of-life situations. Among a number of straightforward questions, there are three choices I needed to make which have clear ethical implications. Since my father is considered incapable of making this type of decision I have answered on his behalf.

The choices are:

1.CPR

• I do want CPR if it is medically appropriate
• I do not want CPR at all

2.Life Prolonging Measures (e.g. ventilator, dialysis, feeding tube, surgical intervention)

• I do want to be transferred to acute care for life prolonging measures if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging measures

3. Life Prolonging Medical Support (e.g. antibiotics, fluids and medications)

• I do want to be transferred to acute care for life prolonging medical support if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging medical support

How would you answer? (You can qualify your choices)


Let me be clear that I’m not looking for advice. I’ve already answered. I also answered similar questions a few years ago on behalf of my mother and my kids are aware of my personal wishes on these issues.

OB

I faced the same decision when my father passed away. He was a lot younger but in substantially worse condition. I decided based on his condition that I did not want him to be revived. But then I was asked if I wanted a feeding tube surgically placed in him and I said yes. I decided that we had to feed him but if he died there was no sense in reviving him. He died the night before he was scheduled to have the feeding tube placed. I don't regret the decision.

In your case, if it was me, I would make the same decision. One of the things you have to take into account is how much harm CPR will do to him. I knew a woman in her eighties who basically died at home but was revived by paramedics and taken to the hospital and put on life support. In order to keep her alive she would have had to have her arms and legs amputated because of the damage she had suffered. Those things are never easy.

Not reviving a person is not the same as ending their life. They are dying of natural causes. I hope you are not offended by any of this.

 

[Occams Barber]

I faced the same decision when my father passed away. He was a lot younger but in substantially worse condition. I decided based on his condition that I did not want him to be revived. But then I was asked if I wanted a feeding tube surgically placed in him and I said yes. I decided that we had to feed him but if he died there was no sense in reviving him. He died the night before he was scheduled to have the feeding tube placed. I don't regret the decision.

In your case, if it was me, I would make the same decision. One of the things you have to take into account is how much harm CPR will do to him. I knew a woman in her eighties who basically died at home but was revived by paramedics and taken to the hospital and put on life support. In order to keep her alive she would have had to have her arms and legs amputated because of the damage she had suffered. Those things are never easy.

Not reviving a person is not the same as ending their life. They are dying of natural causes. I hope you are not offended by any of this.

Thanks @HTacianas. I'm not at all offended. I went through the process when my mother died and something similar 18 months ago when my sister passed away. My answer to all three questions was 'do not'. I don't regret that decision since it saved much suffering and allowed for a peaceful, pain free death.

I hope my kids do the same for me.

OB

 

[Occams Barber]

1) do

2) would indicate a serious life threatening situation without a likely good outcome. don't

3) mild to moderate threat do (also prevents then from doing a medically favoured technique with the elderly of withhold food and water while still conscious to hurry the inevitable)

One of the problems with CPR in the elderly is it can result in significant damage as @HTacianas has already mentioned. Sometimes there is a point where attempts to save life can do real harm.

Of the three questions the CPR question was the one which most occupied my mind.

OB

 

[Jamdoc]

Do Not Resuscitate?

My father is 100 years old. Late last year he was diagnosed with progressive dementia and certified incapable of looking after himself safely. As a result, I placed him into a very nice Aged Care facility. I am now his legal Guardian. Apart from dementia he is fit and well and on no significant medication.


Following a minor medical problem, the care facility realised that I had not given them a Care Plan – basically answers to a range of questions connected to potential end-of-life situations. Among a number of straightforward questions, there are three choices I needed to make which have clear ethical implications. Since my father is considered incapable of making this type of decision I have answered on his behalf.

The choices are:

1.CPR

• I do want CPR if it is medically appropriate
• I do not want CPR at all

2.Life Prolonging Measures (e.g. ventilator, dialysis, feeding tube, surgical intervention)

• I do want to be transferred to acute care for life prolonging measures if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging measures

3. Life Prolonging Medical Support (e.g. antibiotics, fluids and medications)

• I do want to be transferred to acute care for life prolonging medical support if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging medical support

How would you answer? (You can qualify your choices)


Let me be clear that I’m not looking for advice. I’ve already answered. I also answered similar questions a few years ago on behalf of my mother and my kids are aware of my personal wishes on these issues.

OB

I look at it as is there a real chance of them coming back to a quality of life that they want to live or not.
I also look at it as do they know the Lord or not.
If they know the Lord, I'm more inclined to let them go especially if there's no real chance of them coming back to a good quality of life to depart and be with the Lord is far better, especially if they are actively suffering.

So on those 3 questions....

1. No, if they love the Lord and they go into cardiac arrest while in a terminal illness.. go to the Lord, and be at peace.. rather than struggle to stay in the flesh. CPR is not comfortable, intubation is not comfortable, and neither is chest compressions on an old frail body (it often breaks ribs, putting them in more pain)
If they're still unsaved.. well.. that might be the last chance.. a brush with death I guess if they can be brought back and saved. I'd hope it didn't take until then to accept Christ though.

2. same here, the procedures are too invasive and they may preserve life but no quality of life, if I were in that postition I'd want to be let go unless there's a real chance of recovery to quality of life. You might say there's miracles, but if it is God's will to have a miraculous recovery, He can do it without human assistance.

3. Depends on the medication, antibiotics unless the side effects are more miserable than the infection, yes, because having a bacterial infection can be painful and cause more discomfort.. in the case of terminal illness I think that comfort and allowing loved ones to visit is the 2 key things. IV fluids to prevent dehydration can also be a comfort thing. provided they can start the IV without too much distress. Harsh Chemo trying to treat a terminal cancer though? Nah.

 

[SkyWriting]

Do Not Resuscitate?

My father is 100 years old. Late last year he was diagnosed with progressive dementia and certified incapable of looking after himself safely. As a result, I placed him into a very nice Aged Care facility. I am now his legal Guardian. Apart from dementia he is fit and well and on no significant medication.


Following a minor medical problem, the care facility realised that I had not given them a Care Plan – basically answers to a range of questions connected to potential end-of-life situations. Among a number of straightforward questions, there are three choices I needed to make which have clear ethical implications. Since my father is considered incapable of making this type of decision I have answered on his behalf.

The choices are:

1.CPR

• I do want CPR if it is medically appropriate
• I do not want CPR at all

2.Life Prolonging Measures (e.g. ventilator, dialysis, feeding tube, surgical intervention)

• I do want to be transferred to acute care for life prolonging measures if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging measures

3. Life Prolonging Medical Support (e.g. antibiotics, fluids and medications)

• I do want to be transferred to acute care for life prolonging medical support if it is medically appropriate
• I do not want to be transferred to acute care for life prolonging medical support

How would you answer? (You can qualify your choices)


Let me be clear that I’m not looking for advice. I’ve already answered. I also answered similar questions a few years ago on behalf of my mother and my kids are aware of my personal wishes on these issues.

OB

A slim majority of people I know choose not to have chemotherapy that would prolong their life.
I'd likely go that direction.

 

[Occams Barber]

I look at it as is there a real chance of them coming back to a quality of life that they want to live or not.
I also look at it as do they know the Lord or not.
If they know the Lord, I'm more inclined to let them go especially if there's no real chance of them coming back to a good quality of life to depart and be with the Lord is far better, especially if they are actively suffering.

So on those 3 questions....

1. No, if they love the Lord and they go into cardiac arrest while in a terminal illness.. go to the Lord, and be at peace.. rather than struggle to stay in the flesh. CPR is not comfortable, intubation is not comfortable, and neither is chest compressions on an old frail body (it often breaks ribs, putting them in more pain)
If they're still unsaved.. well.. that might be the last chance.. a brush with death I guess if they can be brought back and saved. I'd hope it didn't take until then to accept Christ though.

2. same here, the procedures are too invasive and they may preserve life but no quality of life, if I were in that postition I'd want to be let go unless there's a real chance of recovery to quality of life. You might say there's miracles, but if it is God's will to have a miraculous recovery, He can do it without human assistance.

3. Depends on the medication, antibiotics unless the side effects are more miserable than the infection, yes, because having a bacterial infection can be painful and cause more discomfort.. in the case of terminal illness I think that comfort and allowing loved ones to visit is the 2 key things. IV fluids to prevent dehydration can also be a comfort thing. provided they can start the IV without too much distress. Harsh Chemo trying to treat a terminal cancer though? Nah.

Thanks @Jamdoc

I think we are pretty much in agreement although I would be reluctant to unnecessarily prolong life (and possibly suffering) in the hope of a deathbed conversion. In this case the Old Man is indifferent to religion and I'm a non-believer, so the chances of a last minute change of heart are slim.

In my mother's case, unfortunately my father insisted on prolonging chemo therapy. I don't think he realised that the 'cure' was worse than the disease. Eventually I talked him out of it and she passed away quietly. This was 10 years ago.

OB

 

[RedPonyDriver]

It was gut-wrenching to sign the DNR order for my husband. He had terminal cancer. We chose to stop treatment and go on hospice. The radiation to his brain took his ability to walk, drive, care for himself. He still had seizures. He was too weak to endure more chemotherapy that wasn't going to cure him. He had a grand-mal seizure that may have been a result of one of the tumors rupturing a blood vessel in his brain (I don't know for sure I didn't choose to have an autopsy done, we knew what killed him). He sank into a coma and died just over 2 days later. I chose to let him go peacefully. He just stopped breathing. I am at peace with that decision. I knew he was saved and would go to the arms of the Lord.

 

[Occams Barber]

A slim majority of people I know choose not to have chemotherapy that would prolong their life.
I'd likely go that direction.

I saw the impact of prolonging chemo therapy on a 90 year old woman who was deaf, blind and suffering from dementia. She was my mother and it took a lot of work to convince my father to let her go peacefully.

OB

 

[SkyWriting]

I saw the impact of prolonging chemo therapy on a 90 year old woman who was deaf, blind and suffering from dementia. She was my mother and it took a lot of work to convince my father to let her go peacefully.

OB

My daughter had Chemo when she was three, and I don't regret that. She has two kids now.
But I know I don't recover well anymore.

 

[Occams Barber]

It was gut-wrenching to sign the DNR order for my husband. He had terminal cancer. We chose to stop treatment and go on hospice. The radiation to his brain took his ability to walk, drive, care for himself. He still had seizures. He was too weak to endure more chemotherapy that wasn't going to cure him. He had a grand-mal seizure that may have been a result of one of the tumors rupturing a blood vessel in his brain (I don't know for sure I didn't choose to have an autopsy done, we knew what killed him). He sank into a coma and died just over 2 days later. I chose to let him go peacefully. He just stopped breathing. I am at peace with that decision. I knew he was saved and would go to the arms of the Lord.

Thank you - I'm glad you're at peace. I know that letting go of your loved one through a DNR decision can be difficult.

When it reaches the point where death is inevitable, I think it's our responsibility to make things as peaceful and painless as possible, even if this means that death comes a little earlier.

OB

 

[Quid est Veritas?]

There is a difference between Euthanasia and non-escalation of care. The latter can be an option if further intervention is deemed futile. A patient is autonomous, so can refuse further intervention if they so desire.

In my own case, I want the whole hog. If I go into renal failure, I want dialysis catheters and dialysis. If in respiratory failure, I want to be intubated. In cardiac failure, I want CPR and defibrillation if called for, and certainly inotropic support. I want a CVP and a nasogastric tube. I don't say this flippantly, as I realise the risks and the issues with these interventions - I myself often work in ICU, and intubating people is my profession as an Anaesthetist. Most doctors try and do what is best for the patient in their opinion, and there are people that walk out of ICU that have no business being alive still.

Do not go gentle into that good night.

 

[Occams Barber]

There is a difference between Euthanasia and non-escalation of care. The latter can be an option if further intervention is deemed futile. A patient is autonomous, so can refuse further intervention if they so desire.

In my own case, I want the whole hog. If I go into renal failure, I want dialysis catheters and dialysis. If in respiratory failure, I want to be intubated. In cardiac failure, I want CPR and defibrillation if called for, and certainly inotropic support. I want a CVP and a nasogastric tube. I don't say this flippantly, as I realise the risks and the issues with these interventions - I myself often work in ICU, and intubating people is my profession as an Anaesthetist. Most doctors try and do what is best for the patient in their opinion, and there are people that walk out of ICU that have no business being alive still.

Do not go gentle into that good night.

Fortunately Quid this thread isn't about you and what you would do for yourself. It's about making difficult decisions for others where death is close to inevitable. It's about the awful decision of trading off time against quality of life. Its about making a decision which will result in death in the belief that, in the overall scheme of things you've done the right thing.


You may not wish to go gentle into that good night but, in some situations, this is the best gift we can give to those we love.

OB

 

[timothyu]

A friend of mine died recently. He was in the hospital in the final stages of a cancer during a covid outbreak. His family felt he was fortunate when he caught it and died sooner than normal from it but with far less pain and troubles his cancer would have given. When ya gotta go sometimes there are easier ways.

 

[Jamdoc]

Thanks @Jamdoc

I think we are pretty much in agreement although I would be reluctant to unnecessarily prolong life (and possibly suffering) in the hope of a deathbed conversion. In this case the Old Man is indifferent to religion and I'm a non-believer, so the chances of a last minute change of heart are slim.

In my mother's case, unfortunately my father insisted on prolonging chemo therapy. I don't think he realised that the 'cure' was worse than the disease. Eventually I talked him out of it and she passed away quietly. This was 10 years ago.

OB

Well, I just go back to people I've lost and I wish now that I would have witnessed to them. It's a regret of mine to know that Grandma and Grandpa.. are probably now suffering worse than they ever did during their cancers.
Just.. any chance no matter how desperate for them to accept the Gospel would be better.

 

[Occams Barber]

Well, I just go back to people I've lost and I wish now that I would have witnessed to them. It's a regret of mine to know that Grandma and Grandpa.. are probably now suffering worse than they ever did during their cancers.
Just.. any chance no matter how desperate for them to accept the Gospel would be better.

I'm not a Christian, but I find it hard to believe that the Christian God would punish your Grandparents simply for not believing. I would prefer to believe that your God cares about what people do for each other, for their neighbours, for their kinfolk. I can't tell you that your grandparents aren't suffering but it seems to me that a merciful God would judge people based on what they do - not what they believe

But I'm an atheist - what would I know?

OB

 

[Robban]

Well, I just go back to people I've lost and I wish now that I would have witnessed to them. It's a regret of mine to know that Grandma and Grandpa.. are probably now suffering worse than they ever did during their cancers.
Just.. any chance no matter how desperate for them to accept the Gospel would be better.

Take it easy on yourself.

You don't decide anything.