Do Not Resuscitate? - Real ethical decisions

Tanj

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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

Everything you describe I have with my mother for the last 5 years. I answered no to all of the above. She really died 10 years ago when my father did, and the child like unaware husk that remains is not "quality of life".
 
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Quid est Veritas?

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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
Of course there are times we can just step back, I agree. But the time vs quality of life argument is far more difficult than people think. Afterall, a person might gain let us say a year with a colostomy bag and thrice weekly dialysis, while they otherwise might have died in a month. Humans cannot estimate who will live how long in many cases - hence "doctors only gave him a year to live, but look" trope. At what point is further experience or the possibility thereof, trumped by the effort to keep it going? That is why Euthanasia statutes descend into killing depressed teenagers eventually, after starting with terminal illness. The reasoning is very fuzzy around quality of life, and the time gained or lost an unknown quantity usually. I also don't understand how we can determine whether the qualia experienced by someone else would be worse than no experience at all, or even the possibility of any experience that may occur.
 
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Occams Barber

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Everything you describe I have with my mother for the last 5 years. I answered no to all of the above. She really died 10 years ago when my father did, and the child like unaware husk that remains is not "quality of life".
There's this awful point where I found I wasn't sure whether my perception of my mother's situation matched whatever she was actually experiencing. Was she suffering or was I just projecting my view of how things ought to be? I eventually came to see that her 'blankness' (your 'husk') was real. This was the point where I challenged the continuation of chemo therapy. This eventually led to her death.

I am comfortable with this.

OB
 
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Occams Barber

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Of course there are times we can just step back, I agree. But the time vs quality of life argument is far more difficult than people think. Afterall, a person might gain let us say a year with a colostomy bag and thrice weekly dialysis, while they otherwise might have died in a month. Humans cannot estimate who will live how long in many cases - hence "doctors only gave him a year to live, but look" trope. At what point is further experience or the possibility thereof, trumped by the effort to keep it going? That is why Euthanasia statutes descend into killing depressed teenagers eventually, after starting with terminal illness. The reasoning is very fuzzy around quality of life, and the time gained or lost an unknown quantity usually. I also don't understand how we can determine whether the qualia experienced by someone else would be worse than no experience at all, or even the possibility of any experience that may occur.

Perhaps my last post was too subtle. Let me be blunt. You are treading all over the difficult and emotional experiences of other posters in this thread. Please leave the thread and do not come back.

OB
 
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Jamdoc

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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

That's the thing. we're all deserving of punishment. It's not for not believing in Jesus that you get punished, you get punished for your sins and all of us have sinned.
Jesus has just provided a way out of getting what we actually deserve. It is unmerited grace.
God is loving but He also must have justice. Jesus being a substitute for us for our punishment is kind of a legal loophole, God takes out His justice on His own son, and we're forgiven.
 
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Quid est Veritas?

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Perhaps my last post was too subtle. Let me be blunt. You are treading all over the difficult and emotional experiences of other posters in this thread. Please leave the thread and do not come back.

OB
I am sorry. This was posted in the debate forum, under Ethics, so I thought the purpose was to debate the issue of when such is justified. If it is merely about others' emotional experience, then my posts were uncalled for. I apologise wholeheartedly.

I shall withdraw.
 
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Akita Suggagaki

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For someone with dementia at 100 I would say no to all and go comfort care, especially if I know that is what the person would want. For me at 66 I am still willing to give it a try. Maybe n my 70's I will fell differently.
 
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The happy Objectivist

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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
Let him go. My Grandmother who I loved dearly fell and broke her hip. It never healed but she lived on another year, in excruciating pain. She was blind and losing her hearing, 95 years old, couldn't get out of bed. I was happy that she died in her sleep because she wasn't suffering anymore.

I wouldn't want to live if I lost either my use of my body or my mind. You might find this unbelievable but I take comfort in knowing that when I'm in that condition, I can just go and not suffer any more.
 
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public hermit

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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

Given a similar situation I would:

1. Do not
2. Do not
3. Do

I would be worried that "do not" for #3 might create a situation that causes undue suffering. For example, not giving antibiotics when infection is present and would cause considerable suffering if left untreated.

Question: Couldn't scenarios under #2 be decided cases by case instead of beforehand like #1? I can imagine scenarios for #2 where I would say "do not" and others "do" and none of them being a decision needed at the moment if I were not present like #1. Does that make sense?
 
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Occams Barber

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Given a similar situation I would:

1. Do not
2. Do not
3. Do

I would be worried that "do not" for #3 might create a situation that causes undue suffering. For example, not giving antibiotics when infection is present and would cause considerable suffering if left untreated.

Question: Couldn't scenarios under #2 be decided cases by case instead of beforehand like #1? I can imagine scenarios for #2 where I would say "do not" and others "do" and none of them being a decision needed at the moment if I were not present like #1. Does that make sense?


It makes sense.

Anyone making this type of decision is not necessarily locking themselves in. In my case I could add all sorts of qualifiers about when and under what circumstances treatment should be given. Answering these questions also provides guidance to the carers who may need to react to an emergency situation. Assuming there is time, I will still be contacted for a decision based on the specific circumstances.

In broad terms what I have said is that death should, as far as possible, be painless and peaceful. I've also said that quality of life is as important - perhaps even more important - than prolonging life.

OB
 
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Occams Barber

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Let him go. My Grandmother who I loved dearly fell and broke her hip. It never healed but she lived on another year, in excruciating pain. She was blind and losing her hearing, 95 years old, couldn't get out of bed. I was happy that she died in her sleep because she wasn't suffering anymore.

I wouldn't want to live if I lost either my use of my body or my mind. You might find this unbelievable but I take comfort in knowing that when I'm in that condition, I can just go and not suffer any more.
If it comes to the crunch I will let him go. It's a decision I've had to make on two previous occasions.

Having said that I suspect the Old Bugger will outlive Methuselah. He tootles around happily with his walker and still has enough hair to need a regular haircut. :)

OB
 
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PloverWing

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I had a DNR order in place for my father, who died a few years ago in his 80s in an assisted living facility. It's worth reading the fine print -- in my judgment, for example, a feeding tube is intrusive in a way that giving antibiotics is not. But the general principle is there. When it's time to go, it's time to go. One of the factors in my decision is what others have said about how damaging CPR can be to the elderly body; the medical staff at my father's residence talked about that when they were advising me.

I also agree with the advice to having an Advanced Directive in place, so that when it's your turn, your family members won't have to guess about what you want.
 
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Occams Barber

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I had a DNR order in place for my father, who died a few years ago in his 80s in an assisted living facility. It's worth reading the fine print -- in my judgment, for example, a feeding tube is intrusive in a way that giving antibiotics is not. But the general principle is there. When it's time to go, it's time to go. One of the factors in my decision is what others have said about how damaging CPR can be to the elderly body; the medical staff at my father's residence talked about that when they were advising me.

I also agree with the advice to having an Advanced Directive in place, so that when it's your turn, your family members won't have to guess about what you want.


A couple of days ago the care facility contacted me when the Old Boy got into difficulties after aspirating something (probably a morsel of food). I basically had 3 choices:
  • adopt a wait and see attitude
  • as above plus antibiotics to counter any potential bacterial infection
  • call the ambulance and send him to hospital

I opted for the middle course. Sending him to hospital would have been the safest option but knowing his attitude to hospitals and the likelihood that it would prompt him demanding to go home I decided to hold off. Rightly or wrongly I decided that the security of sending him to hospital was offset by avoiding upsetting him. Under different circumstances I may have opted for the hospital.

Like you I am not inclined to agree to intrusive procedures in an end of life situation. At that point it seems to me that the focus should be on making him comfortable and secure.

OB
 
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Seems like a reasonable choice to me. How is he doing?
He's fine today. He had a visit from the geriatric doc this morning and appears to be OK. According to the doc his vitals are 'normal' - whatever that means for a 100 year old.

Since I live 1,500 km away from where he's located I'm dependent on his doctors, nurses and carers to keep me informed about what he's up to.

OB
 
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In broad terms what I have said is that death should, as far as possible, be painless and peaceful. I've also said that quality of life is as important - perhaps even more important - than prolonging life.

I agree. I had to watch my mother scream incoherently in pain as the brain damage from the series of strokes caused her muscles to contract and spasm. The doctors and nurses would not prescribe enough pain medication to stop the pain. I thought then and I still think now that I wouldn't let an animal suffer that way, why did my mother have to?
 
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The happy Objectivist

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If it comes to the crunch I will let him go. It's a decision I've had to make on two previous occasions.

Having said that I suspect the Old Bugger will outlive Methuselah. He tootles around happily with his walker and still has enough hair to need a regular haircut. :)

OB
Well, that's good that he's able to get around and is still enjoying life somewhat and he's not in pain. It's good that he's in a facility too because at home he could fall and break a hip and at that age it's usually the end. My Grandmother was such a wonderful person, it was hard watching her in pain. She had the heart of a nine-year-old girl, full of wonder and enthusiasm into her 90's.
 
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Occams Barber

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I agree. I had to watch my mother scream incoherently in pain as the brain damage from the series of strokes caused her muscles to contract and spasm. The doctors and nurses would not prescribe enough pain medication to stop the pain. I thought then and I still think now that I wouldn't let an animal suffer that way, why did my mother have to?


I can't imagine the sense of helplessness you would feel watching your mother suffer. Although it probably doesn't happen often, I think there are times when assisted dying can be justified. I say this as a non-believer. I realise that many Christians would disagree and I respect that view.

OB
 
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I can't imagine the sense of helplessness you would feel watching your mother suffer. Although it probably doesn't happen often, I think there are times when assisted dying can be justified. I say this as a non-believer. I realise that many Christians would disagree and I respect that view.

OB

I AM a believer and truly think there are cases where assisted dying is actually the most moral thing to do. It took my mother 2 weeks to die. She was in agony the whole time.
 
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