what is your openion about DNR ( donot resucitate)

papawjohn · Nov 24, 2005

Hey Realnurse

Gosh, I started to dash off a little note but checked your 'profile' and found you're in OMAN. So let me start off by saying to ya (and all the international folks here) that it is a special pleasure to have a forum like this for world-wide communication. When I was a little guy I had a pen-pal in Germany (as we called it then: WEST Germany--how things change). It was such a cumbersome thing to write and wait for a month or more for a reply--I think we exchanged maybe 2 or 3 letters and with juvenal impatience, let the correspondence die. But I've always thought what a special thing to communicate across time and distance.

Here in the USA we had a recent situation that had very big news and political coverage. It involved a tragically brain injured young woman named Terri Schiavo whose Mother & Father are very conservative Christians and who felt that their daughter had periods of alertness and responsiveness. But her legal guardian was her husband who did not believe that she was actually responding as her parents described. He said that she had said before her injury that she would not want to live in a 'vegitative' state. So he wished to remove the feeding tube that kept her alive. Many courts and political leaders got involved and it went on for a long time--months! Essentially the courts ruled in the favor of the husband and the politicians sided with the parents who were supported by the small but active "Conservative Christians" who have made quite a strong political front in the US for several years.

After her death an autospy was done which seems to indicate that her brain was so severely injured that it was unlikely that her parents were actually seeing purposeful responses.

(To the US based readers--I live near the hospice where Terri died. Had firm opinions. Have tried to be non-partisan. Mean no offense to those here who might hold strong views--one way or another.)

Many Americans have taken notice of this and have taken the trouble to fill out legal forms called Advanced Directives or DO NOT RESUSITATE Orders. I am seeing many many more people with these than I have in years past.

There is an unusual distinction however. It seems that most African-Americans do not chose to make themselves or loved ones DO NOT RESUSITATE. There is a strong religious strain in their variation of our American culture that leads them to (mostly) say, 'God will take them when He is ready.'

What are the ways the Arab/Muslim people you care for deal with Death & Dying issues?

Papaw John

zambezi, BSN, RN · Nov 24, 2005

I think that the DNR decision is one's own personal decision. That said, I think that doctors/nurses other health care professionals need to really really work on education of the public (particularly the docs- they need to discuss this with every patient on admit). I think that there are funny things that go on too...I have seen DNR orders overturned by insistent family members, which in my opinion is wrong if it was throughly discussed with the patient prior to the patient not being able to make his/her own decision(thankfully I have only seen this once). "Chem code only" (which in my opinion is somewhat pointless if you have no A, B, or C how likely is it that meds will work- I guess it doesn't hurt to try). There is alot of grey area too...is the patient a full DNR? DNR with full active treat? What if you have been doing everything and then the patient is changed to a DNR- do you continue with what you have going on turn everything off....if the family is all on the same page then these questions are a little easier. If the family is divided at all it can be a nightmare...

I think that the patient and their family have the right to choose their "code status". I think education needs to be done too.

I too am curious what the options are where you live?

dorimar, BSN, RN · Dec 1, 2005

Oh my gosh.... I did a paper on this topic years ago. it was controversial then, and remains so today. I believe it is all about education. Most family members who won't let go, just don't understand. Everything is relative. If a son has seen his mother decline over the years, he may truly not see how bad off she is, and how horrible her quality of life is ( and yet he is asked to make the decsion to "stop the heroics") When really the question might be, "When did it stop being standard care, and become heroics?" " I mean we've done everytning up till now, and now y'all just want to give up????" Modern medicine is tough. We, on the outside, see horrible suffering with poor prognosis. We have to suction them & do painfull wound care, as we watch every organ fail. They, on the inside, see their wife of 43 years, whom they have loved dearly, and we are asking THEM to make that pivotal decision. Who can make such a decsision without knowing? I wish we could bring a TV camera into our daily jobs and show the world what our patients endure. The general public just doesn't understand the miracle of modern medicine enough to forsee what they might endure, all for a heart rhythm, poorly perfused pulse, and ventilated breath. It breaks my heart daily. I do NOT blame the families that just don't see. I fear I will have a battle on my hands when my loved ones become terminal, because my family cares deeply, but doesn't understand.

elthia · Dec 1, 2005

Given a long enough life span, EVERYBODY will die eventually. I believe the best thing anyone can do for their family is to discuss your wishes in advance just in case it ever happens that you are unable to speak. My family has had many discussions about our desires. I'll quote my sister, "I'd rather have my daughter remember that Mommy used to play with her, but Mommy died when she was young. Instead of having my daughter remember that Mommy just lays in bed in a vegetative state and is never able to play with her."

However, I strongly believe that DNR does not mean DO NOT TREAT.

Fairemaid · Dec 1, 2005

What bothers me the most about this topic is the fact that family members can overturn a patient's decision. I don't believe that the DNR status, if made by the patient of sound mind, should ever be overturned. What's the point, after all? :angryfire

Rebecca RN

GooeyRN, ADN, BSN, CNA, LPN, RN · Dec 1, 2005

I have to agree w/ Fairemaid on this one...

**RosesrReder, BSN, MSN, RN** · Dec 1, 2005

It's a personal issue and decision.

Marie_LPN, RN, LPN, RN · Dec 1, 2005

A DNR is a personal decision.

Dad is DNR, he told me this, so that i wouldn't be "surprised" one day. I could see why. You could code, and yet be breought back in worse shape. Quality of life matters.

Same reason why, even though i'm still in my 20s, i'm a DNR.

**RosesrReder, BSN, MSN, RN** · Dec 1, 2005

A DNR is a personal decision.
Dad is DNR, he told me this, so that i wouldn't be "surprised" one day. I could see why. You could code, and yet be breought back in worse shape. Quality of life matters.
Same reason why, even though i'm still in my 20s, i'm a DNR.

Same here. :)

jschut, BSN, RN · Dec 1, 2005

What bothers me the most about this topic is the fact that family members can overturn a patient's decision. I don't believe that the DNR status, if made by the patient of sound mind, should ever be overturned. What's the point, after all? :angryfire
Rebecca RN

:yeahthat: :yeahthat: :yeahthat:

trishtravelsrn · Dec 2, 2005

our hospital does not have anything available other than COR or NO COR. There is not a partial or chemical cor. Either you are or you aren't. In our ICU many times it is the nurse who approaches the families for the first time regarding COR status of a loved one who has taken a turn for the worse or who was Coded mistakenly against thier wishes in the field and is now failing on a ventilator and major medications. As health professionals we need to approach this issue with honesty, respect and allow the family to make a decision that will best serve their loved ones needs. It is a hard enough time without us being judgemental or harsh. We must be compassionate and allow them time to grieve but make a timely decision also so we hold their hands as they make the hardest decision of their lives many times.