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Do Not Resuscitate–Information from Hospice worker

A workshop attendee asked a question about a Do Not Resuscitate form. The following contributing information is from Adam, Hospice Nurse, Phoenix, Arizona.

Now – as for the answer to that question. I think she was talking about “What are the limitations of treatment if a person has a DNR (do not resuscitate) provision/wish in their advanced directives often found in living wills.” That’s actually a good question and I thought we touched on that a little bit during the conference, but probably not enough. Too many people get confused about DNR’s. At face value, it means that if a person is found to be unresponsive and not breathing/without a pulse – that they do not want heroic measures used to bring them back to life. Usually this encompasses defibrillator shocking of the heart, CPR, the use of medications to “jump start” the heart, and/or placing the person on a ventilator to keep them breathing. What often confuses people however is that a DNR/”do not resuscitate” does NOT mean “do not treat”! By no means should the DNR be interpreted to mean that if a person has an infection or serious illness that they shouldn’t receive proper medical care. The DNR is only meant to cover should the person stop breathing and/or have no pulse. **However, many people have special provisions in their advanced directives/living wills that spell out SPECIFICALLY what treatment they would like to receive or not receive should they become ill and it’s THOSE wishes regarding treatment that cover the important things that if NOT instituted would normally LEAD to a person’s breathing and heart stopping. Often these special provisions cover artificial feedings -either via IV or feeding tubes, receiving antibiotic treatments for infection, and even whether or not someone wants to be hospitalized should they become ill. The trend today in society is to cover your bases as much as possible so your loved ones are not left scratching their proverbial heads and wondering what they THINK you would want done if you were not able to make healthcare decisions for yourself at that moment. For example – in my own living will I’ve written in my own special provision directing my Medical Power of Attorney (MPOA,) that should a day come where I can not feed myself AND I do not present as “enjoying” food anymore, that I want any/all assisted feedings to stop. I made this decision based on many years of visiting group homes and nursing homes and witnessing people who were unable to talk/communicate being led to tables, sat down, and hand-fed pureed “goop” by nursing staff. There often was no joy in those folk’s eyes and their quality of life had definitely diminished drastically. I decided that I don’t want to be one of those poor souls. That kind of a decision is a “quality of life versus quantity of life” dilemma. I share this personal example just because it shows that there is NO end to what special provisions you can put into your advanced directives. A DNR is a great place to start if that’s the decision you’ve made when it comes to foregoing heroic measures to save your life either in a traumatic instance (this applies to much older people normally,) or anyone with a terminal illness that realizes what the inevitable outcome will be down the road and wants to make sure no heroic measures are taken. But DNR does not on it’s own mean “do not treat” those things that if left untreated could lead up to a persons potential demise…so make sure you spell out any/all provisions related to other types of medical treatment in your advanced directives/living will. And NO adult is too young to start making these provisions known. You can update/amend your advance directives any time you choose – so don’t be afraid that once you make a decision that it’s set in stone. Your healthcare decisions are just that…yours!

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