June 9, 2014

Are DNR Orders Followed?

In another discussion with one of my doctors, he ordered me to have a living will and a DNR (Do Not Resuscitate) order on file. I asked why and explained that with the number of doctors ignoring them when a family member would not honor them and requested lifesaving attempts, should I even consider having them on file. Even the hospital he worked for often bypassed them to honor the wishes of the family.

What followed was an unpleasant discussion about the reasons wishes of the family came first. I said that is one reason that all I have on file is a medical power of attorney for the one family member that will follow my wishes. No other family member is authorized to speak for me. If they are allowed to bypass the designated family member, legal consequences are to be imposed on all parties, especially the family members that try to interrupt the medical power of attorney.

The doctor was not happy about this, but I explained that this was the only way I could enforce my wishes over the hospital and other family members. This would ensure that the hospital could not bypass the medical power of attorney without consequences and puts other family members on notice to step aside for the person with authorization to act for me.

This happened before this blog was published on the website Center for Advancing Health. It has a great discussion about DNR, and how it is often ignored. The author is well qualified to write about this and explains several medical terms often misused. She writes about how doctors abuse DNR and often refuse to treat younger patients for whom they have a DNR on file. The following is how bad DNR is misused and abused.

Most recently, physicians and nurses caring for pediatric patients also told interviewers that in practice, DNR means far more than just "do not perform CPR." In this survey of 107 pediatricians and 159 pediatric nurses in a hospital setting, 67 percent believed a DNR order only applies to what to do after a cardiac arrest – but 33 percent said it implied other limitations. And 52 percent said that once a DNR order is in place, a whole host of diagnostic and therapeutic interventions should be withdrawn, over and beyond CPR, and a small but disturbing minority, six percent, said that a DNR order means that comfort measures only are to be provided.”
The above is one more reason I will not put on file a DNR order and will limit my wishes to the medical power of attorney. The blog author covers several other terms that are being used, but again doctors are not having the proper discussions with the patient.

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