Showing posts with label DNR. Show all posts
Showing posts with label DNR. Show all posts
Friday, September 9, 2011
Do Not Resuscitate
This brief but thought-provoking article from Contemporary Retirement Coaching raises an important issue: too many people fail to leave a health directive document that lets others know of their wishes in an end-of-life situation. Do you have a medical directive in place? Click here to read the article.
Friday, June 3, 2011
Patients with DNR orders may face poorer outcomes
Here is some real food for thought, especially for those of you out there who haven't bothered with signing a health care directive. The results of a recent study suggest that patients with a DNR ("do not resuscitate") order were at least twice as likely to die shortly after surgery.
Click here to read the article from http://anthonyssong.blogspot.com/.
I recommend that all adults have a health care directive in place. As I've said many times before, think twice - or maybe three or four times - before you include a DNR direction. DNR does NOT mean "if I am in a vegetative state let me go, or a chronic disease has wasted me down to nothing, end my suffering".
It means that you do not want to be resuscitated at all, ever, under any circumstances. Even if you are otherwise healthy but have a heart attack or stroke from which a person might normally expect to recover. If your document says "DNR" you don't get a chance to say "oh but THIS time I want to be resuscitated, this isn't what I meant".
This might be a good time to look at your own health care directive and remind yourself of what it says.
Click here to read the article from http://anthonyssong.blogspot.com/.
I recommend that all adults have a health care directive in place. As I've said many times before, think twice - or maybe three or four times - before you include a DNR direction. DNR does NOT mean "if I am in a vegetative state let me go, or a chronic disease has wasted me down to nothing, end my suffering".
It means that you do not want to be resuscitated at all, ever, under any circumstances. Even if you are otherwise healthy but have a heart attack or stroke from which a person might normally expect to recover. If your document says "DNR" you don't get a chance to say "oh but THIS time I want to be resuscitated, this isn't what I meant".
This might be a good time to look at your own health care directive and remind yourself of what it says.
Monday, December 6, 2010
Is AND better than DNR?
I've had a problem for a long time with the over-use and misuse of the DNR ("do not resuscitate") message found in health care directives. It's poorly understood by the public for one thing. And according to this article in the New York Times, there is no consistency in use between hospitals, doctors and nurses. A new phrase - "allow natural death" - is being proposed instead. Click here to read the article. Let me know what you think.
Monday, July 19, 2010
Why "do not resuscitate" might not be the right words
As part of comprehensive estate planning, most people will have a Personal Directive (also called Health Care Directive, Advance Directive, or Health Care Proxy, depending on where you live) prepared for them. A Personal Directive appoints someone to be your decision-maker and spokesperson on health, medical and personal decisions if you should lose your ability to make those decisions for yourself.
When I am meeting with clients about these documents, they often tell me that they want a document that says "DNR" or "Do Not Resuscitate". Most of the time, people are quite confident that this is exactly what they want, but it almost never is.
What they want to express is that if they are in a vegetative state and if higher functioning cannot ever be restored no matter what is done, they don't want to be kept alive artificially.
Unfortunately, that's not what DNR means.
What if the person who wouldn't want to be kept alive artificially if in a vegetative state is not in that state but is healthy. What if he or she has, say, a heart attack or stroke. He or she would most likely want to be resuscitated as the incident has nothing to do with a vegetative state. He or she could be expected to recover from a heart attack or stroke, if not completely then certainly well enough to carry on a happy life for many years. But not if their document says DNR.
DNR is a blanket instruction that would apply to all situations, not just the vegetative state. DNR means not to revive the person at all. Ever. When this is explained to people who have just told me they want DNR in their documents, they are sometimes quite shocked that they almost instructed the exact opposite of what they want.
If you have documents in place right now that include a DNR instruction, think about what that could mean for you, and consider whether it's what you really intend. I've spoken to a number of doctors who see these DNR documents in hospitals who say they agree with me that the people signing them did so without having any idea of the consequences.
When you're not able to speak for yourself, words matter. Make sure yours are the right ones. It's worth the time and money to get your document done properly so that there are no unintended outcomes.
When I am meeting with clients about these documents, they often tell me that they want a document that says "DNR" or "Do Not Resuscitate". Most of the time, people are quite confident that this is exactly what they want, but it almost never is.
What they want to express is that if they are in a vegetative state and if higher functioning cannot ever be restored no matter what is done, they don't want to be kept alive artificially.
Unfortunately, that's not what DNR means.
What if the person who wouldn't want to be kept alive artificially if in a vegetative state is not in that state but is healthy. What if he or she has, say, a heart attack or stroke. He or she would most likely want to be resuscitated as the incident has nothing to do with a vegetative state. He or she could be expected to recover from a heart attack or stroke, if not completely then certainly well enough to carry on a happy life for many years. But not if their document says DNR.
DNR is a blanket instruction that would apply to all situations, not just the vegetative state. DNR means not to revive the person at all. Ever. When this is explained to people who have just told me they want DNR in their documents, they are sometimes quite shocked that they almost instructed the exact opposite of what they want.
If you have documents in place right now that include a DNR instruction, think about what that could mean for you, and consider whether it's what you really intend. I've spoken to a number of doctors who see these DNR documents in hospitals who say they agree with me that the people signing them did so without having any idea of the consequences.
When you're not able to speak for yourself, words matter. Make sure yours are the right ones. It's worth the time and money to get your document done properly so that there are no unintended outcomes.
Wednesday, February 3, 2010
Do you need a lawyer to do a personal directive?
Yesterday I had a seminar (yes, I do a lot of these!) with a group of customers from the main branch of Scotiabank in Edmonton. One of the questions I was asked during the session, and which I've been asked a number of times before, is whether a person must have a lawyer to draw up a Personal Directive.
A Personal Directive is a document that appoints someone to make health-care and personal decisions (such as where to live) for you if you can no longer make those decisions for yourself due to diminishing mental capacity.
You can make a legally effective Personl Directive without a lawyer. But as I always tell people who want to know what they "can" do, the question is not whether you can do it, but whether you should do it.
Remember that legal documents like this give people a lot of power over you. You need to be sure that they are done right.
Also remember that it's really easy to make mistakes when you make your own documents. People don't always fully understand legal terms or the consequences of certain words. One of the things people say to me when we discuss Personal Directives is that they want a "DNR" (do not resuscitate) provision in their document. Usually what people mean is that if they are dying of a chronic disease, such as cancer, and the disease takes a turn for the worse, they don't want to be kept alive artificially. But that's not what DNR means. DNR means "do not take any steps to bring me back no matter what the circumstances". So, if the person has, say, a heart attack from which he or she would normally be expected to recover, but has DNR on the document, the medical staff won't take action.
When I explain this to people, they are usually horrified at the idea that they almost made a huge error like this. As I said, it's easy to make this, and many other, mistakes and not even know it if you prepare your own documents. To keep costs down, most people have Personal Directives made at the same time as their Wills and Enduring Powers of Attorney.
If however, you have decided that you want to do your own Personal Directive, either for financial reasons, because you are geographically isolated and don't have access to a lawyer, or for any other reason, please look at the Government of Alberta website first. Click here to access it. This site has clear explanations, a precedent document, and information about the provincial Personal Directive registry.
A Personal Directive is a document that appoints someone to make health-care and personal decisions (such as where to live) for you if you can no longer make those decisions for yourself due to diminishing mental capacity.
You can make a legally effective Personl Directive without a lawyer. But as I always tell people who want to know what they "can" do, the question is not whether you can do it, but whether you should do it.
Remember that legal documents like this give people a lot of power over you. You need to be sure that they are done right.
Also remember that it's really easy to make mistakes when you make your own documents. People don't always fully understand legal terms or the consequences of certain words. One of the things people say to me when we discuss Personal Directives is that they want a "DNR" (do not resuscitate) provision in their document. Usually what people mean is that if they are dying of a chronic disease, such as cancer, and the disease takes a turn for the worse, they don't want to be kept alive artificially. But that's not what DNR means. DNR means "do not take any steps to bring me back no matter what the circumstances". So, if the person has, say, a heart attack from which he or she would normally be expected to recover, but has DNR on the document, the medical staff won't take action.
When I explain this to people, they are usually horrified at the idea that they almost made a huge error like this. As I said, it's easy to make this, and many other, mistakes and not even know it if you prepare your own documents. To keep costs down, most people have Personal Directives made at the same time as their Wills and Enduring Powers of Attorney.
If however, you have decided that you want to do your own Personal Directive, either for financial reasons, because you are geographically isolated and don't have access to a lawyer, or for any other reason, please look at the Government of Alberta website first. Click here to access it. This site has clear explanations, a precedent document, and information about the provincial Personal Directive registry.
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