The DNR decision?

Windyridge...Thanks for asking. I am 75 years old in November. I was forced to retire because of health reasons in 2010. I was 69 then.
There must have been 50 to 60 Nurses in the room. It was the best attended Bar Association Presentation that I was ever in front of. I was a last minute substitute for the speaker who was attending a weekend retreat. Soon after starting I realized how committed the nurses were to the DNR. They were angry. Anyone who raised their hand got a chance to speak. I didn't argue with anyone but did give my truthful opinion of the state of the acceptance of the DNR Directives. No one else spoke up against the abuse of the DNR. In my Mothers case she was swept away with signing the DNR by the facility that had a neat package of admittance to their facility. When she changed her Health Care Directive from when she signed the DNR in 2002, the facility reasoned that she had more of her mental facilities being so much younger than when she changed her directive in 2015. My argument was that she woke up to the probability of a hospital stay and she did not want to die if an antibiotic or fluids were withheld. We were having and enjoying a blessed existence. It didn't make sense to Mother, myself or son to have such a low bar to withhold treatment.
Rogue facility means the corporate environment was corrupt and lying was standard behavior. The well-fare of a resident was low on their agenda.
The facility made a fortune after they injured Mother, she paid for 2 rooms for the time when she was in their Health Care Center and she had to also pay for her independent living apartment at the same time. They did not permit her to go back to her Independent Living Apartment even though she was still paying for the apartment. She was forced to go to Personal Care, after the Health Care Center. The Nurses Aids who took her to breakfast negligently brought her back to her room and sat her in front of the TV in her LR when she couldn't ambulate of navigate the chair. She couldn't reason to push her button to call an aid. She had multiple falls and each fall would make her sicker and fog up her mind. I have gone over and over these details in Aging Care as I want to warn others what can happen when I hear their Questions. I appreciate all the answers to the questions I had. Aging Care and the Lord got Mother and I out of the rouge facility and into a very nice facility near where I have had a home since the mid 80's. It is like a different country and culture here. People, especially the staff here are loving and kind.
Thank you for your compliments. My son and his wife are great support and we also pay for Caretakers one night a week when I practice with the choir and on Wednesdays for 4 to 5 hours so I can keep Dr. appointments and/or go shopping. It is importance to keep yourself mentally and physically healthy when you are a Caretaker.

Hm. Normally I'm all for leaving it to the patient to decide if he wants to give the Hail Mary option a go; and I agree that pacemaker insertion should be comparatively trouble-free for even a frail patient. But in this particular instance, with Susan's father, I'd like to look that cardiologist in the eye and ask him to justify the treatment in clinical terms. I wonder what he suggested it might achieve? I'm sorry, Susan, I agree it is a great pity the discussion wasn't delayed until you or another representative were there to hear it. But I also agree with Veronica that it probably won't have made much difference to your father's condition during those last two weeks. I'm so sorry for your loss.

Daughterlu,

You used to be an attorney. What happened?

Your presentation stirred up a hornets nest.  How so?

"Rogue facility". What exactly does that mean?

And how do facilities make more money with patient turnover ? I would think they'd want the place full and not be constantly regiggering rooms, people and new care plans.

Your mom is lucky to have you, your son and all the help she gets. And you are also very fortunate to not be the sole caregiver.

I came back to my hometown when Mom asked me to Jan 2015. When I looked over her legal papers she had a very fatal DNR. She was staying at a rogue Senior Facility that liked to move seniors forward with DNR's. They tried to block my having her draft a new Health Care Directive. We got it done and I am also Mother's Health Care POA. Everything is left up to me. When I did a presentation for Nurses on Health Care Directives approx 2004 for the local Bar Association, it stirred up a hornets nest. I was an Attorney then. They were all for DNR. They shared some stories about how the Dr.'s leave it up to them. Praise God for Mother's sake that I had that experience. We are planning her 100th Birthday October 29. Had I not experienced the Presentation I might not have intervened so strongly on Mother's behalf. Some Nurses gave stories about how the Doctors are so busy they leave it up to them and the (inappropriate) ways they deal with getting the families ok on a DNR.
Mother was hospitalized for pnemonia and according to her DNR Health Care directive they would not have given her fluids, antibiotics and a raft of other things she needed on that occasion and for another time she was hospitalized after a serious fall. God meant her to have these years. We moved Mother to a better private facility. Myself and her Kitty are her 24 - 7 full time caregivers. We also have a friend who stays with Mom 1 evening a week while I go to Choir practice and a retired Nurse who comes in 5 hours a mid week day for shopping and appointments. My Son watches Mom or they join me at church on Sunday mornings and his wife helps out once in a while. These are blessed precious loving family days and we have a system to prevent any falls. These are the good family times that escaped Mother and I during most of my life. She is pleasant and loving telling me she doesn't know what she would do without me. (It is vice versa). Mother could live to 106 and God Willing I will be with her. Her life would have been snuffed out too early by the DNR Health Directive she had at the rouge facility where she used to reside. Once the new Health Care Directive was in place, they retaliated by setting her on a path of negligence and destruction where she would have been sure to die. They dug me through the mud and cut my hours when I tried to stop them. My son got her out of there alive but invalid and with her glaucoma sever to the point were The Charles Bonnet Syndrom set in, she was having visual hallucinations from their failure to properly administer eye drops, a sign of end of vision. Mother has improved greatly since our move, she can walk around her room or down the hall with her walker and her eyes though damaged have stabilized. She has not had any more visual hallucinations. There is a point where you don't want a LO to suffer anymore, when there is no longer happiness, love and a quality of life. Don't be caught up in the rhetoric. This is just a business to too many facilities and Institutions. They want turnover. They make more money that way. Protect your LO. God Bless.

A DNR to be valid must be on file at the hospital or a separate out of hospital document.
The Dr was either over enthusiastic or felt it was the responsible thing to do to offer the procedure..
I can perfectly understand any patient when offered the choice of a procedure or certain death choosing the procedure. As surgery goes putting in a pacemaker is not a big deal and does not carry the risks of open heart surgery or the long recovery. I realize he was 101and the treatment did not give him any quality of life in his final days. But the thing to remember is that he would probably had suffered without the pacemaker as well.
Unless someone has been declared incompetent they are free to make their own decisions which your FIL obviously did.
So sorry FIL's final days were filled with suffering. Try not to second guess things that can't be altered.
It is a normal part of grieving to try and find someone else to blame so try and let that go and get on with the grieving and move forward.

There is a note I carry in my wallet that says NO to DNR and to put a tube in after electric shock - should my Mother have a heart attack and I am speechless. I carry that and my POA for Health Care.  I have been told it is a gentle procedure and it used to be a permanent thing but that there are tubes that are not    permanent and not so painful that are removed as the patient heals. 

My father-in-law was 5 Days short of 101. He was taken to the hospital from his ALF after complaining of chest pains. By the time I got to the hospital, the doctor had offered a pacemaker. My fil had all the paperwork and DNR and I thought it was irresponsible for this option to be offered. The other option he, he was told was to keep him comfortable and he would probably pass in within a short time. Because he was able to make the decision, I was told that I could not, even though I was the person on his legal work. Therefore, my opinion didn’t count. They proceeded with the pacemaker, he turned 101 a few days late, and died 2weeks after the procedure. He suffered and never made it out. They should not have given this terrible option.

I just ran across this question as I'm new to this forum. My mom expressed her wishes for a DNR to her primary care with no result. We reiterated her desire with the nurse practitioner. After trying to get one signed for over a year I printed out a form from a website and brought it to her last appointment. The nurse practitioner looked at it and had no clue what it was. Sad state of affairs as mom has been seeing this same provider and np for most of her adult life. It's really sad that the majority of the practice seems to be geriatric and they have no clue.

If Daddy is still in his right mind, it is never too late for a living will.

Basically, you are refusing resuscitation and can also refuse what is known as heroic measures. There are things that will be beyond your control and the hospital will tell you when needed. Things like going onto a respirator - this is a doctor's decision and he told us his opinion and then we had to decide. Since my dad and sister wanted mom on the respirator, the doctor pulled me aside and asked me to speak with them. It was not in my mother's best interest.
It was easy enough - I just asked my dad if it was him in the bed, what would he want me to do. He cried but he said, no respirator. Then my sister followed his wishes against her own feelings. She believed mom would come out of it, but my mother was gone, only the body remained.
Before it is too late, ask your dad what he wants.
They will also ask in the hospital!  Also, if he doesn't wish to go to the hospital, you can call Hospice Care and they too will question him about what he wants.

Call Hospice at once. You will have support with them. Google Hospice in your area and start the process. This is the support you need and they will walk you through this. Don't let yourself be alone. I just did it for my Mom and she is home under care to make her comfortable. Yes, there is a DNR.

Everyone has the right to make their own decisions which includes using alternative or "natural" forms of treatment.
Some people do find canabis very helpful in controlling nausea during chemo treatment and if it is legal where you live I would not be opposed to trying it.
However falsely raising someones expectation of a cure with herbal treatments may raise the moral but finally the disease will probably win.
however I would not encourage anyone to spend money they don't have on alternative therapy or any other experimental treatment for that matter.
DNR or not someone eventually has to make the decision to turn off the life support.

i'm not sure what to do either except to encourage him to get as much out of his life as absolutely possible and encourage him to live. I would try to encourage cannabis since it's becoming legal everywhere. Ohio legalized it for medical use, you might try that and research how to reverse various cancers naturally. Believe it or not, people actually used to live well into their hundreds even several hundred years and they were very healthy. If you live in America you'll notice the American diet is actually very poor. Your dad must've either been a smoker or been around it or some other air pollutant for him to have gotten lung cancer. Definitely look into cannabis, it's widely known to reverse cancer and save lives. Cannabis is not only good for reversing cancer, but it's also good for other life-threatening ailments

There is no right or wrong answer here. After being hospitalized several times, my mom, fully cognizant of what she was doing, signed a DNR while in ICU. I was not there at the time. My older brother was. A week later, after a massive stroke, I was left with the decision (as her POA) whether to intervene. Since she was DNR, the hospital wouldn't keep her and she was sent to hospice. The family was divided on the issue. I chose to allow her order (her wishes) to stand. She had three more strokes and died after a week. I was accused by a sibling in front of her casket, of "allowing" her to die. Two years later, I still second guess that decision. Either way will guilt you.

Be sure concerns over such decision do not take away anything from the time you have with him while he is still here on earth. Count every moment a blessing.

You really don't have to do anything you don't want to do. You don't have to except this as a task. Just tell your dad you love him but you're really not in a position to do this. Explain to him he's paying the consequences for choosing to smoke and he must make his own decisions on this matter. All he has to do is have an advance directive filled out with his local doctor and even the local hospital. Taking a copy of the advanced directive of his choice to that hospitals record department and turning it in will allow the person behind the desk to put a copy on file for his record, this does not have to be shifted onto you. Let him make the decision and let him take care of it himself, it's possible to do this on your own since it's a personal decision. It's sad when anyone decides to allow their lives to end

Dear Tinyblu,

I'm so sorry. Its an overwhelming decision. There is so much emotion and its always hard to know if we are making the right decision. After my dad had his stroke my siblings did not want any heroic measures. My dad did not want to be in nursing home. He wanted to be independent as long as possible. He was not the same man after the stroke. There were no more smiles or laughter. Just existing but I thought it was good enough. Then he had a series of heart attacks. He passed away in hospital. I wanted him to live longer. But everyone tells me that CPR would have been too violent. And he would have suffered more and it was better to let him pass peacefully.

I never wanted to be selfish. But in this moment four months after my father's death, I desperately want him to be alive. I wanted them to do everything and anything possible so that my sibling could have seen him one more time. Maybe this is not rational. Its a very heart wrenching decision to make. I still question if I made the right one.

Thanks Veronica. I wrote that down on a slip of paper and will keep it in my wallet so in an emergency I will not be lost for words and congratulatioins on the success of your operation.

Daughterlu they can try and restart the heart with electric shocks but may need to put in tube to assist breathing but they do not automatically have to crush someones chest.
My answer was they could shock me a couple of times and then my husband who was right there would make the decision of how to proceed from there. I was warned that I might wake up with a tube in my throat and it might need to remain for a couple of days. My reply was "so be it" I had a ruptured appendix and was in septic shock both of which have a very poor survival rate. Wasn't ready to throw in the towel but hubby would not have let me suffer.

Mother was recently in the hospital. She made me POA over all her medical decisions. She was brought in for pnemonia. When asked my automatic answer is that it depends on the circumstances. I was holding Mothers hand and said I am not leaving her side. The doctor came in to give me a little lecture from the point of view of her age and fragility. She had pnemonia and no heart trouble. There is a prejudice that at near 100 the patient is dying and to let them die. No thanks if they are living. I stood firm to ask me at the time but I wasn't sure until afterwards the nurse said, CPR can be done in a gentle manner. Can an elderly person be revived without breaking there breast bone? There is not to much information out there. A DNR leaves no space for an elderly patient to survive if they could be revived in a manner the nurse suggested...gentle. Science does so much why can't they come up with acceptable resusitation for the elderly with frail bones or as the Nurse suggested for the Dr. to go as far as they can without the more violent means to restart a heart that can be used on a younger person. The right to life movement for unborn children is making headway. We need a right to life for the elderly. We are blessed every day by Mother being here on earth with us.

Mother was recently in the hospital. She made me POA over all her medical decisions. She was brought in for pnemonia. When asked my automatic answer is that it depends on the circumstances. I was holding Mothers hand and said I am not leaving her side. The doctor came in to give me a little lecture from the point of view of her age and fragility. She had pnemonia and no heart trouble. There is a prejudice that at near 100 the patient is dying and to let them die. No thanks if they are living. I stood firm to ask me at the time but I wasn't sure until afterwards the nurse said, CPR can be done in a gentle manner. Can an elderly person be revived without breaking there breast bone? There is not to much information out there. A DNR leaves no space for an elderly patient to survive if they could be revived in a manner the nurse suggested...gentle. Science does so much why can't they come up with acceptable resusitation for the elderly with frail bones or as the Nurse suggested for the Dr. to go as far as they can without the more violent means to restart a heart that can be used on a younger person. The right to life movement for unborn children is making headway. We need a right to life for the elderly. We are blessed every day by Mother being here on earth with us.

I think a DNR decision should be something that everyone over 45 years of age should have to renew yearly and have it signed by a witness. If you are feeling really depressed one year and feel like you have nothing to live for it may seem like a good idea at the time. You may think differently next year when everything has improved and you are on top of the world. It may seem like a hassle at the time but at least your information will always be up to date and accurate and no one will feel like they are signing a death sentence for someone.

OMG Veronica! It used to be they RESCINDED DNRs for people going into surgery. Good for you for refusing. What are we coming to that life is so devalued that we try to end it sooner than necessary or appropriate?

I was asked to sign a DNR right before being anesthetized with a ruptured appendix in septic shock. Not a very good prognosis but I refused and was then asked how much they should do. I told them they could shock me a couple of times and after that hubby would decide based on my condition. I do have advanced directives in place which were signed a number of years ago. If I should progress to the point where death was inevitable I would definitely sign and accept hospice

The human body has an expiration date and, fortunately, we are blissfully unaware of that date! Does it really matter how old a person was when they signed the DNR?

When the prognosis is bad and the cure is worse than the disease, DNRs are supposed to spare the person (and his/her loved ones) from the torture of being kept alive by heroic feats and artificial means.

If someone is extremely ill, suffering, fading away, and there is absolutely no hope of anything good happening in the future to change that situation, then I feel you have no choice but to be kind and compassionate and do whatever you can do to end the suffering. It is the right and only thing one can do. Not to do this is selfish and uncaring and just downright mean.

Tinyblu

I have been where you are right now. I was an only child, parents passed separately and I was left to make decisions for my father. This is the best advice I can give.

Your father: Think back over the life you have shared. Ask his PC doctor if they had this discussion prior to this time. Ask yourself if he is still competent to make his own decisions for Health Care. If he is still competent for his health care, your answer is his answer. In other words do what he wishes, even if they are outside your personal believes. During your lifetime were there ever occasions when you father purposefully entered into a conversation regarding what he would want. Probably this discussion would be at the time of a relative’s death. Try to remember if he had this discussion any other time stating his discussion. Speak with his clergy regarding this decision and listen to what they say. These things will allow you to make an informed decision.

About your feelings of being overwhelmed, this is normal considering your situation. I know I was at this time in my life. Get involved in a support group, even long distance caregivers will benefit from the experiences of others. The facilitator for this group should tell all at the beginning of the meetings 'what is said in this room, stays in this room'. See your medical provider, explain this to him/her and ask their advise for you. My doctor totaled me the best medical advice I have ever had. 'Set a time each day, it does not matter when and go for a walk. Each time you put your foot down, let that be the release for your frustration and anger'. I would suggest make sure you are in a safe place to walk. Many businesses and establishments offer a plan for walking to the members of the community at no cost. Being safe will give you the opportunity to truly focus on you. This is very important, for your health.

Truly, you are not alone. And there are people who can help. Tinyblu

I have been where you are right now. I was an only child, parents passed separately and I was left to make decisions for my father. This is the best advice I can give.

Your father: Think back over the life you have shared. Ask his PC doctor if they had this discussion prior to this time. And if he is still competent to make his own decisions for Health Care. If he is still competent for his health care, your answer is his answer. In other words do what he wishes, even if they are outside your personal believes. During your life time was there ever occasions when you father purposefully entered into a conversation regarding what he would want. Probably this discussion would be at the time of a relatives death. Try to remember if he had this discussion any other time stating his discussion. Speak with his clergy regarding this decision and listen to what they say. This things will allow you to make an informed decision.

About your feelings of being overwhelmed, this is normal considering your situation. I know I was at this time in my life. Get involved in a support group, even long distance caregivers will benefit from the experiences of others. The facilitator for this group should tell all at the beginning of the meetings 'what is said in this room, stays in this room'. See your medical provider, explain this to him.her and ask their advise for you. My doctor totaled me the best medical advice I have ever had. 'Set a time each day, it does not matter when and go for a walk. Each time you put your foot down, let that be the release for your frustration and anger'. I would had make sure you are in a safe place to walk. Many businesses and establishments offer an are for walking to the members of the community at no cost. Being safe will give you the opportunity to truly focus on you. This is very important, for your health.

Truly, you are not alone. And there are people who can help.

Woo, Riley. That was a bit tough. We really have to use our best judgment if we are medical proxies. DNRs may have been signed 10 years earlier when death was not really considered relevant to the signer. They are signing something in theory. A good example is my parents. Both have a DNR and I am their proxy. My father was ready to go when it came his time, so we accepted the DNR and did not try to resuscitate. My mother, OTOH, has only recently begun to tire of living. I knew that before now executing the DNR if something were to have happened would not be what she really wanted. At the present time that is changing and I'll know that she really wants the DNR to be executed if her heart fails. It is the purpose of the medical proxy to guide the doctors in what the patient would want at that point in his/her life. We shouldn't say, "Well, you signed the paper, so it's your fault." We have to use some wisdom based on our knowledge of the person.

In my book, any decent, sane person should make up a living will when they are well. To refuse to recognize what could happen is just simply stupid and selfish. If they don't do that and something happens, than let the chips fall where they fall - they made their bed and now have to lie in it. In other words, it is THEIR fault what is going to happen - you did nothing wrong. Never let guilt overtake you. If people are stupid, then let them pay the price - they earned what they get.

You cannot play God if you wanted to. God gives all life and determines it's span.

Dee, grant you that the "disease" of being human has a mortality rate that eventually approaches 100% - but often death can in fact be postponed, for a short time, or a life time. Every intervention should be weighed by its own pros and cons. Chemo that will give you 2 months extra survival, while totally miserable with side effects, maybe no - chemo that will be miserable for 6 months but give you years may be a different matter. People who are in skilled care and will not be going home but love seeing grandkids and getting something out of being here should have reasonable interventions - people in end stage dementia who aren't getting anything out of life any more maybe should just get care that keeps them comfortable. Just my 0.02 - interventions are not all futile, though not always necessary or appropriate, grant you that too.