Morality of DNR orders


#1

Are DNR (do not resuscitate) orders morally just? I’ve learned from watching the documentary Life Itself that there was such an order concerning the late Roger Ebert.


#2

I used to work as a paramedic.

I certainly hope they are moral.

All they do is try to reverse what God’s intentions actually are.

As medics…if we find someone who is seriously sick, elderly and knocking on death’s door already…what good would it do to try and chemically or electrically kick start their lives again?
But that is our job and we have the medicine and technology to bring someone back.

However it would make them sicker and it’s just delaying the inevitable.

Most families have a hard time with it because they just aren’t ready to see their loved one go yet.

God wants us to go when He is ready…a DNR actually helps with this process.


#3

People are permitted to die, yes.

DNRs are a refusal of extraordinary medical care, and are thus morally acceptable, because people are allowed to refuse extraordinary medical treatment.


#4

I agree DNR orders are moral. I had a recent cancer scare and thought about this quite a bit. Trying to decide where I’d want the line drawn. We as humans have the right to die with dignity (not talking about euthanasia). I knew what my limit would be as far as treatment in regards to quality of life, distress on my family, and quite frankly financially.

So yes, I would have had a DNR order set long before I became sick enough to need it. Fortunately the cancer scare was just that, a scare.


#5

Yes, but not everyone should have one.

You also want to make sure that a DNR means just that.

Some medical professions see it as more. Yes, I had a nurse ask why someone was still receiving their maintenance medication since they had a DNR. Um, DNR means to not use extraordinary means to keep someone alive. Giving someone their insulin isn’t extraordinary means. :shrug:


#6

My brother, at 44 yo, coded (went into cardiac arrest) and was down for one minute. The hospital lost his DNR or refused to recognize it for some technical reason. When he was coherent enough, I told him about the successful resuscitation. He said something the forum moderators won’t let me post.:stuck_out_tongue:

My brother won’t tell us what happened but after he coded, he got very close to this one priest. He got a rock solid DNR. He has refused every thing but food, water and pain medication. Each of us have gone to our parish priests and they all say my brother can do this. He’s working very hard for his next code blue. He can’t wait to get there.

In contrast, I was with my unit when a man coded because he’d od’d. CPR and Narcan brought him back like flipping on a switch. The charge PMIC told him, ‘‘You were dead sir.’’ He said, ‘‘In Hell.’’ After rehab he tried to find the crew that worked the code. He was grateful to be alive, off drugs and found Jesus.

Kelfa28, don’t you find DNR orders counter intuitive to EMS training? We’re trained to preserve life, alleviating pain is a consequence of what we do?


#7

The National Catholic Bioethics Center has good information about this:

ncbcenter.org/page.aspx?pid=1321

If more details are required, I suggest people contact them.

Ed


#8

I thought if someone has a DNR, the EMS would not be called? Of course, that would be problematic if the person were out shopping and had a heart attack, but overall, stm that if the EMS has to treat, because they are not there to evaluate legal technicalities.


#9

The EMS would be called. They would do everything they could. Later, after the appropriate person(s) were notified, the hospital in question would follow its rules and honor the DNR. But things can be more or less complicated. A first heart attack at a given age is a factor along with the general health of the patient.

Ed


#10

In a way…I do find them counter-intuitive…in a technical way, I suppose.

EMS workers are trained to preserve life and work the code unless the victim meets certain protocols.
We weren’t trained to see the bigger picture at the end of the day…we take care of the here and now problems…not the long term consequences. If someone coded and we were called, we came in and used our training and equipment to prolong life until they reached the hospital and the doctor made a decision.

When it came to DNRs:

We were trained to only recognize the DNR if
A) the order was filled out correctly and every signature was there
and
B) if we had the order in hand

Otherwise…we’d be working the code.

If we had a correctly filled-out order and the doctor we called was comfortable with us not proceeding with CPR and resuscitation efforts…then we were done.

From what I can recall…I don’t think I’ve ever encountered a situation where a patient coded, we got called and then someone presented a properly filled out DNR for us to recognize.
We always worked the code and the patient would usually be pronounced at the hospital.

It’s been several years since I’ve worked in the EMS field. I gave up my ticket to be a wife and mom and also to finish my degree.
So I haven’t really given the philosophical side much thought.

My mother worked in the hospice field for the better part of 20 years and we used to take hospice patients home from the hospital all the time.

I prayed that a family member wouldn’t panic and call 911 when their hospice family member coded and they either didn’t have the DNR or wouldn’t give it to us.
My mom has confirmed that situations like that do happen.

I just couldn’t imagine trying to resuscitate a patient who was that sick and deserved to die with dignity and not be “revived” into the same, or worse, shape they were in before.


#11

Hospitals make mistakes. My dad was not supposed to be given narcotics. The nurse was adamant about giving my dad something for his pain. She gave him dilaudid, he coded. I was not there but my sister said they revived him, put him on a respirator. When he came to and found himself on that, it was worse than dying, his biggest fear. You may imagine the look of terror and anger in his eyes. Thats something hard to forget. The nurse was reprimanded in my presence. First for administering the narc that caused his heart to stop and second, for having a dnr resuscitated.

I do not believe a dnr is moral because of this. Having advanced directives that specify what extraordinary procedures you are comfortable with and when, is better.


#12

I think you’ve hit the nail on the head here.

You are absolutely right in this regard.

Your dad should not have been given pain meds and he coded as a result.

A DNR should never be honored in a situation like this…and advanced directives should be followed instead.

BTW…I’d go after the doctor in a situation like this. Nurses aren’t supposed to do anything without an order…they can’t even give oxygen or an aspirin without a doctor saying so…let alone a hard-core narc like dilaudid.


#13

You’re right, EMS should not be called, but sometimes nurses think they should call anyway. When the EMTs arrive, they will probably resuscitate anyway. It’s legally risky for them to try to evaluate the legality of the DNR.

I can see this from all perspectives, as I’ve been an EMT, an RN, and a health care attorney (at various times of my life). If there is a valid DNR in the chart, no one should notify EMS.


#14

We have a lot of EMT/PMIC. Anyone else hear interesting things from the resuscitated?


#15

There’s one major issue with a DNR order we discovered when my grandpa died of a heart attack. He had a DNR which meant the doctors wouldn’t even keep him on life support so that the priest could come give him Extreme Unction, which I know my grandpa would have wanted. Just something to think about.


#16

I would go so far to say that in certain situations, a DNR is the only moral option. I am a nurse and can’t tell you how many elderly patients we have resuscitated who would have had a peaceful death, only to die a few days later with broken ribs, bruises, and a tube shoved down their throats.

People do not understand how traumatic CPR is - we need to compress at a rate of 100 compressions/minute at a depth of 1.5 - 2 inches. For an elderly person, this is definitely going to injure them badly.

There comes a point when our time is over in this life. I will not put my parents through resuscitation when they are elderly and it is their natural time to die. I am a strong advocate for allowing our elderly to have a peaceful death. Of course it is always the choice of the individual/family but I think people need to be educated that it is not always the best option.


#17

Which is why I always felt horrible about showing up to an elderly patient’s home and they are knocking on death’s door and the family has no DNR order or not a valid one and we have to start CPR and do all kinds of really invasive interventions.

I’d never want to inflict that upon someone who has lived a full life and is ready to go. It would do them more harm then good, in the long run, just to prolong their lives for…what? A couple more weeks…maybe?

The compressions can be really traumatic to a person’s chest…especially an elderly person.
I know when EMS is involved…compressions never stop…there is no pausing when you have a second person managing the airway.
It’s why CPR is so exhausting…you are continuously doing compressions from the moment you realize CPR needs to begin and you either arrive at the hospital or someone tags you out, or you need to use the de-fib pads…which isn’t very often for an elderly patient whose heart has stopped.


#18

I completely agree, Kelfa. It is very frustrating. The family should always have valid copies of DNR/living will/HCPOA on hand for elderly loved ones.

God bless you in your work!


#19

It’s true. There comes a point when continued aggressive treatment is worse for the patient than palliative treatment. And many doctors are simply reluctant to tell a patient that continued aggressive treatment will likely do them more harm than good. I’ve been reading Atul Gawande’s “On Being Mortal,” which narrates quite a few actual accounts of this. He also discusses assisted living and hospice care.


#20

There is a truly fantastic PBS documentary about healthcare for the terminally ill and it proposes the question…when do we say enough is enough?

The lengths that families, let alone patients, will go to…and how difficult a doctor’s job is to navigate treatment and general ethics.

Technology has advanced so far in our world that we can keep people perpetually “alive” for extended periods of time.

Not to mention the fact that terminally ill patients almost always have another option if treatment fails.


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