We stand at a cultural crossroads, the intersection of the Culture of Life and the Culture of Death. At this critical juncture, the choices we make matter, now and forever. Therefore, the members of Life is Worth Living, a lay apostolate, have chosen to promote the Culture of Life.
Our mission is to strive to affirm -- in thought, word, and deed -- the infinite preciousness of human life; to encourage service to others rather than radical self-interest; and to promote a climate of public opinion that recognizes the right of all human beings to life, respect, compassionate care, appropriate medical treatment, and equality under the law.
DO NOT RESUSCITATE ORDER (DNR) TOO BROAD
posted by Julie Grimstad
Thursday, July 17, 2008
Elderly, disabled and seriously ill patients or their proxies (relatives or health care agents) are often asked if they wish to have their doctor put a DNR (Do Not Resuscitate Order) on their medical chart. Here is information YOU NEED in order to make an informed decision -- an excerpt from the book Life, Life Support, and Death: Principles, Guidelines, Policies and Procedures for Making Decisions to Protect and Preserve Life (second revised edition) by Paul A. Byrne, M.D., and nine other physicians as well as Rev. George M. Rinkowski and attorney Mary H. Sadick. It is published by American Life League and is available by calling them at 540-659-4171.
In the Sacred Heart,
Julie Grimstad, Director
Life is Worth Living, Inc.
715=342-4249
RESUSCITATION--LIFE SUPPORT
When it is directed by a patient or the patient's proxy that a medical treatment will not be administered, a specific order for that specific non-treatment must be written. Written orders must be as precise and clear as possible.
"Do Not Resuscitate" (DNR) or "No Code" are examples of imprecise and ambiguous orders widely--and wrongly--accepted by physicians and courts. Do these orders mean no maintenance of an airway, or no ventilation, or no cardiac resuscitation, as well as no new or additional treatment? Furthermore, in light of the weakness of human nature, once the course has been plotted by a DNR or "No Code" order, there is a tendency to preclude, eliminate or reduce ordinary treatments, such as visits by physicians and care given by nurses and others. Therefore, broad orders of "Do Not Resuscitate," "No Code," and similar orders must be avoided. At no other time in medicine are treatment orders that are so broad and non-specific considered to be within the standard of care.
When it is anticipated that a patient could sustain a complication that would be immediately life threatening and not allow time for reflection and decisions, specific orders to direct the Code Blue team response regarding use or non-use of a specific treatment can be written by the primary physician, provided they are also consistent with the life principles and policies discussed herein. For example:
1. In the event of cardiac arrest, use or do not use external cardiac massage, defibrillation, etc.
2. In the event of hypotension, use or do not use Dopamine, Levophed, volume expanders, etc.
3. In the event of respiratory arrest, use or do not use bag and mask ventilation, endotracheal intubation, ventilator, etc.
A companion entry must be made in the medical record, including the diagnosis, prognosis, patient's wishes, recommendaitons of the treatment team or consultants with documentation of their names and the date. When the patient is unable to communicate for himself/herself, attempts must be made to obtain informed consent from a proxy.
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You should review Understanding Your Living will by Addicus Books
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# posted by 
: July 22, 2008 5:59 AM
: July 22, 2008 5:59 AM << Home