So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.
"I do not wish my heart to be restarted through usage of any
chemical, mechanical or physical intervention..."
Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.
As far as I know, the initial decision to perform CPR was correct. A living will applies only if the patient is terminally ill or permanently unconscious. Some states prescribe a period of time in which death is expected to allow invocation of a living will. In Pennsylvania at least, http://www.aging.state.pa.us/aging/l..._brochure1.pdf
The advance directive or living will declaration
becomes effective when:
• Your doctor has a copy of it; and
• Your doctor has concluded that you are incompetent and either in a terminal condition, or in a state of permanent unconsciousness. For terminal conditions or permanent unconsciousness, a second physician must confirm your doctor’s conclusion.
Since the woman in question was neither terminally ill nor permanently unconscious when she collapsed, paramedics would have attempted to revive her even with a living will right in front of them. On the other hand, it sounds like the living will should indeed have taken effect after the efforts in question failed to prevent irreversible and terminal brain damage.
I went through a similar situation in which my father, who had Lewy Bodies' disease (per autopsy), stopped eating and drinking. I was going to have a feeding tube put in because I envisioned him being hungry and thirsty. (The subsequent Terry Schiavo case certainly reinforces this perception, although I understand that they would not offer her liquids by mouth either). Also, his living will said only that he wanted to refuse CPR and artificial ventilation, not artificial nourishment.
(Perhaps fortunately) he died before I could act on the feeding tube. Furthermore, none of his doctors ever pronounced him terminally ill, so I am not sure I could have even refused CPR or ventilation on his behalf. One ER doctor (he was taken there after being unresponsive in the nursing home) asked whether I wanted anything done if his heart stopped, and I told him I had no idea because he had never been pronounced terminally ill as my state's living will law requires.
Although in this case it sounds like a family member was indeed an obstacle to the patient's wishes, the doctors also have a responsibility to make it clear (in writing) their belief that heroic treatment will only prolong the dying process. This is a legal requirement in my state.