DNR Decisions

I overheard a chaplain chatting with a social worker about a patient.

“She [the patient] asked me,” the chaplain said, “if a DNR order would interfere with her getting to heaven.”

My two colleagues slowly moved away from me. I don’t know if the social worker responded, or what the chaplain had explained to the patient after she asked her heavenly question. Maybe my two colleagues continued talking about this patient or shifted to other subjects.

I’m not sure anyone could tell the patient about heaven’s entry requirements. Different faith traditions have different views of the “better place” after death. Humans have pondered Valhalla and Nirvana and Paradise and Heaven for millennia. I’ve read and heard some Christians describe heaven as far more difficult to enter than an Ivy League school. I’ve read and heard other believers claim the “pearly gates” are wide and welcoming for every soul.

Heaven’s rules may be mysterious or debatable, but what about DNR? That was the part of the patient’s question that kept nudging me. It stands for Do Not Resuscitate, and according to webmd.com, it is,

A DNR order is a physician’s written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family, it must be signed by a physician to be valid.

With a signed, office DNR, health care professionals won’t attempt to revive patients experiencing “cardiac or respiratory arrest.” Which likely means, without that intervention, the patient will die. Many have seen CPR done by actors in movies and television shows. It’s often portrayed as successful. After a commercial break, CPR dramatically brought the person—the fictional character in the film!—back to life. Reality, of course, tells a different tale. In a 2009 study published in the New England Journal of Medicine, 18% of senior citizens who received CPR in a hospital survived to be discharged. That meant that 82% did not survive . . . and that’s in a hospital setting.

Furthermore, attempting CPR on the elderly and the seriously ill can result in collateral injuries. CPR can be violent on the ribs that protect the heart, and it’s certainly dangerous for the surrounding organs as unusual physical force is exerted on a vulnerable part of the body. In other words, if I am one of the 18% who “survive” because my DNR order triggered a CPR effort, I may have added the complications of broken bones, serious bruising, and damaged lungs (or other organs) to my list of ailments and anguish.

But who cares about percentages?

Shouldn’t all of us do everything possible to stay alive?

I suspect it’s sometimes the terminally ill patient who makes sure she or he doesn’t have a DNR order. After all, that would be giving up. Or the patient fears death and wants to keep breathing, no matter the consequences. Perhaps, like the patient the chaplain mentioned, the ill person worries that a DNR is against God’s will and could prevent “entry” into heaven. I’m equally confident that others in the family might plead with the patient to have CPR attempted under every circumstance. A spouse or parent isn’t yet ready to lose a loved one. Family members might also dread death, or feel guilty about cultural or religious consequences if someone appears to surrender rather than fight for the next breath.

Hospice will honor a patient’s wishes. If a patient desires every effort made to keep them alive, those efforts will be undertaken. If a patient requests a DNR order, it will be followed.

Do you want a DNR order as one of your health care decisions?

  • Now?
  • Later?
  • How will you decide?

As with many decisions, I hope you openly talk about what you want with your loved ones. Electing to have, or not have, a DNR order is not a trivial choice. Additionally, what you want when you are healthy and vibrant at 50 will likely be different than what you want at 80 after a cancer diagnosis and years of chemo and radiation. Of course, you may change your mind. And then change it again.

I humbly urge you not to keep your wishes and hopes private.

In a hallway, I overheard a snippet of conversation between a chaplain and a social worker. Who knows what they said before or after they walked by me?

Requesting a DNR—Do Not Resuscitate—is a serious decision impacting everyone that matters. Please don’t eavesdrop, guess, or make assumptions about the people you love in your life. Take the time to share what you want and/or to listen for what your loved one wants.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. After my brother’s 13 year coma from a head injury following a dirt bike accident, my family all wrote out our personal wishes about DNR. Later, when my mother lay in an ER room and said to me, “I’m done, ” I was shocked, but it was not as scary of a conversation as it would have been if we had not already talked about what “I’m done” actually meant to her. It is never ever a comfortable conversation to have with anyone, but I am so grateful that I was raised in a family that talked about such difficult issues before these decision actually had to be made. Thanks for your posts on such important and sensitive issues, Larry.

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