QOTD

Stay committed to your decisions,
but stay flexible in your approach.
~Anthony Robbins

You know, I realize he's a great motivational speaker but every time I think of him two images come to mind: hypnotizing Hal in the elevator in "Shallow Hal" and eating Peter's head at the book signing on "Family Guy". Tony hungry!

Ethics Question: What Do You Think?

I am doing a short course on DNR, or do not resuscitate orders. What this means is that when a person expires, if they have a DNR signed, no CPR or "heroics" will be performed and the person will be allowed to die naturally.

So here is the question, lifted from the course, and their commentary. What do you think about this?

What if the family disagrees with the DNR order?

"Ethicists and physicians are divided over how to proceed if the family disagrees. In most hospitals the policy is to write a DNR order only with patient/family agreement.

If there is disagreement, every reasonable effort should be made to communicate with the patient or family. In many cases, this will lead to resolution of the conflict. In difficult cases, an ethics consultation can prove helpful. Nevertheless, CPR should generally be provided to such patients, even if judged futile."

More on DNRs

Here is a clarification, from 'the law'... this is the heirarchy that is utilized for decisions in the case of end of life issues:

Surrogate decision maker: In the absence of a written document, people close to the patient and familiar with his wishes may be very helpful. The law recognizes a hierarchy of family relationships in determining which family member should be the official "spokesperson," though generally all close family members and significant others should be involved in the discussion and reach some consensus. The hierarchy is as follows:

1. Legal guardian with health care decision-making authority


2. Individual given durable power of attorney for health care decisions


3. Spouse


4. Adult children of patient (all in agreement)


5. Parents of patient


6. Adult siblings of patient (all in agreement)

In some cases, these folks can supercede a written DNR, as I mentioned in my last post. In POSLQ or PSSLQ relationships, it would behoove them to establish a DPAHC (durable power of attorney for health care) so that their birth family can't elbow in on their desires. That is because in many states, despite common law arrangements, people living together are not considered spousal health care proxies. I don't know about many of you, but if I was cohabbing I wouldn't want my parents coming in and deciding what to do with me (or my/my SO's adult children). I agree with the comments on the last post regarding self determination and that a signed DNR should be binding, despite the wishes of the family... even a spouse, if it comes to that.

So, wake up call... I realize most of us don't think about this sort of thing every day, much less talk about it, but here's a good opportunity to have that convo with your loved ones, and make it clear what you want/don't want in words of one syllable. Write it down and sign it, file it with your primary physician and your lawyer if necessary. In addition to the fact that CPR is brutal to the delicate (I have drawn the comparison to jumping up and down on an antique accordion wearing army boots), the stats on CPR, even in a hospital setting, are not as pretty as TV would have everyone think:

CPR has been shown to be have a 0% probability of success in the following clinical circumstances:

1. Septic shock


2. Acute stroke


3. Metastatic cancer


4. Severe pneumonia

In other clinical situations, survival from CPR is extremely limited:

1. Hypotension (2% survival)


2. Renal failure (3%)


3. AIDS (2%)


4. Homebound lifestyle (4%)


5. Age greater than 70 (4% survival to discharge from hospital)

2005 List of Banned Words

BLOG – and its variations, including blogger, blogged, blogging, blogosphere. Many who nominated it were unsure of the meaning. Sounds like something your mother would slap you for saying.
“Sounds like a Viking’s drink that’s better than grog, or a technique to kill a frog.” Teri Vaughn, Anaheim, Calif.
“Maybe it’s something that would be stuck in my toilet.” – Adrian Whittaker, Dundalk, Ontario. “I think the words ‘journal’ and ‘diary’ need to come back.” – T. J. Allen, Shreveport, La.

Thanks, gev... fo shizzle! :-p