Do Not Resuscitate (DNR) – Do We Avoid Acting Because Term is Scary?

Most of us tend to put off things we don’t really want to do, even if we know they really need to be done.

Procrastination is human, but in this case risky.

We need to encourage our senior loved ones to execute their healthcare decisions, known as advance directives or DNR, and then make them known to important people in their lives.

Then we need to do the same for ourselves.

We should have those decisions written in a legal way and shared with those closest to us, including our healthcare team. This is something upon which we all agree, no matter what decisions you make or how long you have put it off already.

The number of people who have formally stated their wishes and made them known is rising, not just in the United States but also across the globe — but there are still too many of us who have not done so.

Did you know that only about one third of the general population has completed advance directives, even though these forms are free, straightforward, and easily available?

Advance directives empower individuals to manage the final chapter of life in a dignified manner and according to their own values. If advance directives are not completed, if there has been no conversation to express end of life wishes amongst the family, the result is often medical intervention that can be painful and without dignity when ‘doing everything’ is the only course.

Even if proper advance directives have been executed, if those closest to you aren’t aware of them, they could potentially not be followed as you would like.

What are Advance Directives?

A Do-Not-Resuscitate (DNR) order means that you or your senior loved one opts not to receive cardiopulmonary resuscitation in the event that the heart stops beating. DNR orders cover failure of the heart to beat, in which case CPR or chest compressions are typically performed in an effort to assist the heart beat and force the blood to be once again pumped to vital organs.

Many agree that CPR needs to be withheld if the person involved wishes it to be held. In addition, if the medical team agrees that CPR will be ineffective or has limited potential to benefit the person, life saving measures that could cause further harm should not be performed.

Put another way, will CPR benefit a person if their quality of life is so poor that meaningful survival is doubtful even once the heart resumes beating? This is a decision your loved one, doctor and family should discuss, especially if no written advance directives are in place.

Having a DNR order does not mean that you will not be treated for your medical issues nor that you have given up all desire to live, but that you feel that performing CPR won’t give you a desirable outcome, a good quality of life.

It is important to differentiate between a DNR order and a living will. The rules governing advance directives vary from state to state. It is prudent for you to check with a professional or agency in your state to be sure that the documents your senior has are valid in their state.

Dangers of CPR for Elders

Seniors nearing their end of life or even in the midst of a medical crisis are fragile. As often occurs, broken and cracked ribs are a result of CPR.  Frail, brittle bones crack with each chest compression.

If CPR is “successful” in that it revives our elder, he or she can endure pain and confusion that may last for the rest of his or her life. Oftentimes their life is prolonged for merely hours, days or weeks.

The statistics are grim:

  • about 15% of healthy people who have CPR in a hospital will survive;
  • 1-2% of elderly people will live past CPR performed in the hospital and go home;
  • many of those who do go home after hospitalization have significant lasting medical effects such as brain damage; and,
  • The statistics are worse for CPR performed outside a hospital.

This is not to say CPR is bad or everyone should have a DNR order in place, just that it is reasonable to consider if one wants CPR performed.

Whether or not one wants lifesaving procedures performed is, after all, a personal decision. There are many factors that might go into personal considerations.

Why Should We Make Our Wishes Known?

Besides the potential for further pain and suffering when our senior loved ones might not reap great rewards with desired quality of life, many prefer to die with the same dignity they lived their lives. They choose to allow the natural course of their life and failing bodies to unfold without the lifesaving measures that could keep them alive without dignity or quality of life not to mention further disability.

Most seniors have a view in their mind of their own end of life. They may have expressed it verbally to members of the family and may already have had lawyers prepare the documents.

Some older adults are fearful of talking openly about the subject to those they love because they don’t want to cause them pain. There may be fear that speaking about it will cause untoward events to occur.

If they don’t bring it up, you should. Ease into this discussion but handle it in such a way that shows your love and concern for them.

In the case of natural aging, we can often see our senior loved ones declining and know that they may not have many years ahead. This is a good time to be sure there are documents completed and a discussion is had by all. Unfortunately, in the case of a crisis such as an automobile accident, a fall with head trauma, a stroke or another medical emergency it may be too late or impossible to make wishes known.

We never know when the need could occur, so we should be ready now.

This is not just for your senior loved one but you as family caregiver as well. Planning for how and who will take over your caregiving duties is vital for your senior’s well-being in the event of an emergency involving you.

Would Another Term Be Less Scary?

Many across the healthcare field, especially those who deal closely with end of life issues, have started to use the term “Allow a Natural Death” (AND) instead of DNR. They feel that this term is more agreeable and clear in its intentions. We all want our loved ones and ourselves to have a peaceful and natural death.

In Texas, for example, they are using the term AND to open family discussions of end of life care with better understanding and outcomes.

Discussing resuscitation in terms of the damage it can cause if performed does not paint a very comfortable end for many. The opposite of having a natural death is having CPR performed.

Because this is a deeply personal decision for your senior loved one and even you, careful consideration with all the necessary information to make an informed decision should be taken.

No matter what decision about end of life care is made, it is recommended that you keep a copy of all advance directives, especially a DNR, POLST or Comfort Care DNR form attached to the refrigerator so that everyone can have access during a crisis especially first responders. Your senior’s doctor should have a copy and members of the family.

Don’t keep anyone in the dark, it could lead to disagreement when the time comes it is needed and ultimately lead to the wishes not being followed.

As we plan for our end of life, let’s make each day a reason to celebrate. Here is an important reminder for us all!

Top Five Regrets of the Dying

  1. I wish that I had let myself be happier.
  2. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  3. I wish I hadn’t worked so hard.
  4. I wish I’d had the courage to express my feelings.
  5. I wish I had stayed in touch with my friends.

Source: Guardian News Report

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