Life-and-death choices need to be made in advance
By Anne C. Zimmerman
The Portage Daily Register
March 1, 2004
When emergency medical personnel and police officers respond to help a person who is dying, precise information is required to carry out the person's wishes relating to unwanted efforts to maintain life.
The confusion that can occur when this information is not readily available is stressful for everyone involved. Relatives or friends who know that the patient's desire was to eliminate any attempt to resuscitate still need tangible proof to convince authorities that this is true.
Divine Savior Healthcare personnel are asking that patients 18 or older who have a terminal condition or a medical condition -- such as cardiac or pulmonary failure, where resuscitation could be either unsuccessful or cause significant harm or pain or would be successful only temporarily -- have their "Do Not Resuscitate" forms in order.
Portage Police Lt. Penny Kiefer describes this situation as a major problem.
"Hands are tied without the information. Life-saving efforts must be made which could be the opposite of what the person dying had hoped for," Kiefer said.
Two years ago, the Portage Community TRIAD issued to senior citizens a bright-yellow card to hang on the upper right-hand corner of the refrigerator. The card contains valuable information in case of an emergency, such as the physician's name, location and description of medicines being taken by the resident, medical history and special instructions. These cards are available at the Portage Police Department.
Due to the importance of the Do Not Resuscitate order, emergency personnel are requesting a copy of the order be attached to the card, where it is easily accessible.
In addition, the person is to wear either a free plastic bracelet with an insert signed by the attending physician or a metal DNR bracelet engraved with pertinent information. The metal bracelets must be ordered from MedicAlert by the attending physician.
When a DNR patient needs health care, only comfort care will be given. No life-sustaining CPR or pulmonary care should be provided.
If emergency responders are called and the patient has a DNR order and bracelet, they may not perform chest compressions, insert airways, administer cardiac resuscitation drugs, breathe for the patient or use electric shock to start the heart.
The bracelet also prevents a patient's guardian or health-care agent from revoking the DNR order.
Divine Savior emergency room director Lori Barto says people today are taking more planning measures in making plans relating to death such as funeral arrangements. She spoke on the rights of a patient regarding efforts to resuscitate under certain conditions.
"These are things that hopefully have been discussed with a physician and decisions made," Barto said. "In the case of a terminal illness, to discuss this (DNR) ahead of time is very important."
Barto admits that it is still a subject that may be difficult to talk about, but says it is very necessary in order for emergency personnel to carry out the wishes of the patient.
"Our role as nurses is to advocate for the patient. If we know this is what the patient wants, we will abide by the DNR request," said Barto.
Officer Kiefer pointed out that the subject has to be discussed before confusion sets in, such as may be experienced by an Alzheimer's patient.
Divine Savior social workers Jan Carlson and Pam Crawford point out the importance of choosing a family member or friend who will uphold the patient's desires relating to the DNR order. They are willing to talk with people about the DNR order, free of charge.
Barto agrees that a decision on what the patient wants is extremely important.
"This saves the family from a lot of emotional suffering," she said.