A Do Not Resuscitate Order (DNR), is not the same thing as a “do not treat” request, although there is sometimes confusion in that regard. It simply means that if the patient has a cardiac arrest, the medical team (or nursing home personnel) are instructed to not try and revive the patient. It is not the same thing as the patient stating, “I want to die now,” or “don’t do anything to keep me alive.” It says, don’t give me CPR.
That is why an article in Medical News Today has me concerned. It suggests that patients with a DNR be dissuaded from receiving (or denied?) life-extending surgery based on poorer outcomes for such people than those without DNRs receiving the same procedures. From, “Should DNR Rules Apply to Life Prolonging Surgeries, Procedures?”
Could it be that if a patient has already decided to not continue their life by turning down resuscitation legally, healthcare professionals should save time and money by not recommending or performing surgeries to prolong life? A new study shows that about 70% of Americans die when they have do not resuscitate (DNR) orders in place, after having potentially saving surgeries or not…
Researchers contrasted the surgical outcomes for some 4,000 DNR patients with age-matched patients who’d had the same procedure done but didn’t have a DNR order. Overall, nearly 25% of DNR patients died in the month following their surgery, about three times as many as in the comparison group. That difference remained even after taking into account that DNR patients are usually sicker to begin with, Roman said, although the reasons aren’t clear.
So? That means 75% didn’t die in that time, doesn’t it?
For those who would follow this very bad suggestion, consider this: I can’t think of anything that would more dissuade people from signing DNRs than if they knew that by doing so, their doctors and/or bioethicists would henceforth consider other medical efforts to extend their lives not worth “the time and money.” Good grief.
April 23rd, 2011 | 5:09 pm
That’s freaked me out for awhile, too. I’ve counseled my own family members to hold off on signing a DNR, but to make sure that they’ve designated a health care proxy who knows their wishes. The proxy can agree to issuing a DNR order when the right time comes.
April 23rd, 2011 | 7:56 pm
I read the article but ‘m not sure what the “very bad suggestion” is. If a patient’s condition greatly reduces the odds of life-prolonging surgery being successful, and also increases the odds of prolonged and possibly painful death, shouldn’t this be discussed with the patient (or proxy) beforehand so that an informed decision to undergo it can be made? And shouldn’t the doctor and patient (or proxy) discuss the advantages and disadvantages of DNR in that context? I didn’t see any suggestion that the doctor make the decision unilaterally, without anyone else’s involvement. Did I miss something?
HW
April 26th, 2011 | 12:04 am
It is already happening, I have heard doctors and nurses say “oh, he is a DNR” in response to some non-DNR related issue. Staff gets nervous when a seriously ill person remains a “full-code”. Doctors have little idea which nurse will be less vigilant if someone is a DNR, because if they die, there is no ruckus, no crash cart, no anxiety on the nurses part. Could this be a reason for the 25% in the study who have worse outcomes–staff is just not as careful?
DNR’s should mean nothing more than DNR, but this may just happen on paper in untold cases. Know your doctor’s opinion on this.
HW–the problem is, using “evidence based medicine”, that the label “DNR” could be used to say, “hey, this person doesn’t need this surgery”, thereby neglecting other reasons to perform or not perform a surgery. To answer your 3 questions, in no particular order: yes, yes, yes.
HistoryWriter Reply:
April 26th, 2011 at 9:31 am
@TXW,
“Could this be a reason for the 25% in the study who have worse outcomes–staff is just not as careful?”
I suppose it *could* be. But *is* it? Do you have any proof of it beyond a supposition? You’re implying that DNR is an invitation for staff to commit malpractice because nobody’s going to make a big fuss if the patient dies. I have yet to meet a doctor or nurse who’s that cynical.
As far as I’m concerned (and I speak only for myself, of course) if I thought there was even a remote chance that a medical procedure might cause me to end up in a PVS I’d make doubly sure I had a DNR order on file. I’ve already said as much in my Living Will with respect to food and hydration, and my family are not only aware of it but have agreed without reservation to implement it. Should they fail to, my attorney has been authorized to do so.
To protect against meddlers of various conservative persuasions, I’ve even taken the precaution of authorizing my removal from any jurisdiction in which my wishes are not honored, to any other jurisdiction in which they will be — even if the process shortens my life expectancy. You just can’t be too careful nowadays; look what happened to Terri Schiavo.
HW
Wesley J. Smith Reply:
April 26th, 2011 at 9:52 am
History Writer: But you miss the point, as you so often do. This DNR creep is about making your choices for you. Half troll.
HistoryWriter Reply:
April 26th, 2011 at 11:21 am
@Wesley J. Smith,
You claim the article “suggests that patients with a DNR BE DISSUADED” from receiving life-extending surgery based on poorer outcomes for such people than those without DNRs receiving the same procedures. [emphasis added].
The article makes no such suggestion. It asks a question at the outset: “Could it be that if a patient has already decided to not continue their life by turning down resuscitation legally, healthcare professionals should save time and money by not recommending or performing surgeries to prolong life?” It then goes on to discuss a number of related issues.
Last time I checked we were still speaking English in the USA. Since when did “could it be …?” become the same as “we ought to?” Have folks in WesleyWorld developed their own dictionary? Just asking.
HW
Wesley J. Smith Reply:
April 26th, 2011 at 11:30 am
Not recommending, would either be not telling them it is available, or dissuading them from going in that direction. Not performing would be refusing to do, regardless of patient desires. So, it’s actually worse than I characterized.
HistoryWriter Reply:
April 26th, 2011 at 4:00 pm
@Wesley J. Smith,
No, you said the article suggested that it not be done, which is a misstatement of fact. Or was it, like Sen. Kyl’s famous 90% remark, “not intended to be factual?”
HW
Links
Blogs
Find Us
Contact