<p>^^^^True, but perhaps not everyone living at the assisted living center would feel the same going forward. Also, what about their visitors? If they have an emergency situation with a RN standing several feet away, they are just SOL?</p>
<p>My mom had a DNR and yes, the nurses at her nursing home had to stand back and let her die. It’s a choice the patient makes, not the care team.</p>
<p>^^^As it should be. But at this facility, it’s not a choice the residents necessarily make or their visitors necessarily make, but the company policy.</p>
<p>Hopefully, it is the case that all residents understand and agree with the policy when they sign their leases.</p>
<p>I don’t have any problem with someone who has a specific DNR and that is the reason not to pursue the CPR. IF that were the issue, that would be the end of the case. That was not what the nurse said on the 911 tape, She said that the policies of the place of residence prohibited her to give CPR and she refused then to give the phone to anyone else. The facility is now saying that the nurse did not give the proper information and some actions are being taken against her by the facility.</p>
<p>It’s all well and good that the family felt that way, but who knows what the situation there is? My DH has estranged siblings that would dance a jig if my MIL died and be in line after the funeral for whatever handouts that might be there for them. There is the right way to handle these things and if it was not so handled, there is a serious problem here, and I don’t think the “feelings” of the family are the entire concern here.</p>
<p>If you can stand to read any more about this:</p>
<p>[Amid</a> CPR Controversy, Many Unanswered Questions - NYTimes.com](<a href=“http://newoldage.blogs.nytimes.com/2013/03/06/amid-cpr-controversy-many-unanswered-questions/]Amid”>Amid CPR Controversy, Many Unanswered Questions - The New York Times)</p>
<p>(I would recommend this blog to anyone dealing with the issues that can arise with elderly parents.)</p>
<p>I don’t think the family being thrilled with the results should necessarily have much bearing either.
The last years of someones life can be stressful to their family members. With worrying about having to manage their money so it can last, being worn out from taking them to dr appts & on outings and its not unusual to be frankly relieved when it is over. Especially when they didn’t have to tap into their own savings, but got to distribute the inheritance.
It’s not pretty, but it is often the truth.</p>
<p>The family stated that this was what their mother/grandmother would have wanted. Not that they were “thrilled.”</p>
<p>It’s just random chance that the family is okay with this in this circumstance. If the same worker would have had the same response to someone else that person’s family’s response could be the opposite. This particular family’s response has no bearing on the issue IMO although I’m glad the family is at peace with it in this particular case.</p>
<p>A couple of other points seem to be coming to light -</p>
<ul>
<li><p>The worker who identified herself as a nurse apparently wasn’t actually a nurse.</p></li>
<li><p>The facility is backing down somewhat on its stance of their ‘policy’ and support of the decision the worker made -
</p>
<ul>
<li>A big part of the issue is that the worker wouldn’t comply with the 911 operator and basically refused to do anything including getting someone else involved -
</p>
<p>EK, in this specific instance, I think if the family were motivated by greed they would be chasing some kind of lawsuit against the facility. </p>
<p>I worked for many years on a groundbreaking national initiative on end-of-life decisionmaking. These issues are really hard, and there is plenty of gray area. Unfortunately I think the response to this case is being skewed by the drama of the interchange–the escalating emotion of the 911 operator played out against the flat tone of the caller. As others have noted, if CPR had been administered the overwhelming likelihood (I don’t have the latest data but if I recall it’s on the order of upwards of 97% for those over 80) is that the result would have simply been either an equally rapid but more brutal death or a period of limbo on life support before the woman met the legal standard for brain death.</p>
<p>The ethical standard in situations such as this is that caregivers carry out the wishes expressed by the person whose life is (potentially) ending. Not what they (caregiver) want or what they think is in the patient’s best interest, but what the patient wants. In this case, the family is unequivocal that this is what happened, and while as EK notes families are not always disinterested in this case I just think there is plenty of evidence to suggest otherwise. </p>
<p>So, in terms of the result (death, to put it starkly) in this case, 1) it is almost certain this would be the result even had CPR been administered and 2) this is what the patient wished for herself. </p>
<p>Yes, it’s really hard to listen to that tape. But to pick up on the theme raised eloquently upthread by Kluge, we have a major problem with death denial in this country and coming to terms with that is something we will all have to embrace lest we create really really difficult choices for our children. And not just on a family-by-family basis; we are already seeing a post-sequester situation where we are continuing to fund experimental treatment for patients over 90 with end-stage cancer while we are cutting head start and school nutrition and special ed. </p>
<p>Stopping here lest we drift into politics!</p>
<p>*The family stated that this was what their mother/grandmother would have wanted. *
If that was what she wanted, then she should have had a DNR, and a bracelet or some such to that effect.
Without it, or paperwork saying the same thing, saying she wanted a DNR, is hearsay.</p>
<p>[DNR:</a> Do Not Resuscitate Guidelines](<a href=“DNR Guidelines for Medical ID Wearers | American Medical ID”>DNR Guidelines for Medical ID Wearers | American Medical ID)</p>
<p>You can be motivated by money, but still not want to hassle with a lawsuit.</p>
<p>We don’t know the particulars about this case. The family may have told the facility that they did not want these measures, but no DNR having been filed. My MIL, as confused as she has been, would not sign one, and was appalled when she was read the provisions. There is a lot of hazy ground between declaring someone incompetent and making these decisons for them, and for everyone knowing that the person is not fully competent. You have to go for the legal in these cases. If there is a DNR that the patient has signed, well and good. Otherwise the DNR has to be signed by someone named by POA or by other legal document to be permitted to make this decision for the patient. There is a process that has to be followed and when someone falls in the gaps, life should have the precedence. It has to. </p>
<p>I say this as we are in that situation with MIL. Because we have not declared her as incompetent and and named ourselves or anyone as her guardian, and because she did not give us POA to make these decisions when she could pass as competent and now any POA she signs would not hold water because it is very clear she is incompetent, a legal DNR is not attainable for her. To get there, we have to navigate through some legal and medical channels which we have started down. In our case, it is also a fact that she was adamently against any DNR when cognisant, and I doubt anyone could even get her to agree to one now; it would have to be a con job to get her to agree. But I sure as heck could tell the nursing home or whatever that she doesn’t want CPA or extraordinary measures, and we don’t either but are in limbo as to getting it formalized for the forementioned reasons. </p>
<p>I don’t think any family is foolish enough to act thrilled, even if they are. I went to a funeral, where everyone was relieved and the atmosphere at the viewing was a jovial one. My friend’s mother (my son’s best friend’s grandmother) was 90 something years old and had a lot of issues that had family member hopping a number of times during the past year. The viewing brought a lot of people together who had not seen each other in a long time and, really, the main topics were not how sorry anyone was, (other than son and me) that the old lady had died other than as a perfunctory statement. My son was appalled. But she was a wealthy old lady, and everyone was going to get some money in a few weeks and she had been very needy that past year. At the funeral mass, though, everyone managed to pull a somber face. I’m sure if any news media had any questions, everyone would have given the party line, that they would miss her, they were sad, but they were glad that her suffering was over, and it was her time. Wouldn’t be any law suits over any emergency measures withheld, Uh, uh, uh, uhn!</p>
<p>Now in my friend’s case, the whole thing was civilized. But there are cases when children are hard up and grandma who has left everything to them is going through that money at a rapid clip and some of them are getting concerned. So I don’t go by the family reaction and what they publicly will say. You expect anyone to say, “we’re so glad she is finally dead before she spent all of her money. Plus we are sick and tired of running to the hospital for one emergency after another”.</p>
<p>
</p>
<p>Aha! Just as I suspected.</p>
<p>EDIT:</p>
<p>Actually, the article linked with the quote above does not say she is not a nurse, it said that she was not hired in that capacity. The article goes on to say it was unknown whether or not she was a licensed nurse.</p>
<p>The article linked in post #145 says the cause of death was a stroke. If true, at least in this instance, it appears that CPR would not have saved her. A stroke so severe that it causes respiratory and cardiac arrest so quickly is unsurvivable.</p>
<p>But that doesn’t mean that the issues raised here are moot.</p>
<p>This sort of thing happens all of the time, I’m sure. What made this so horrifying is that the person who identified herself as a nurse or other health care worker specifically said while being taped on a 911 call what she did, and the part that was particularly disturbing was that the assisted care residence did not permit CPR. She did not say that there was a DNR on file, or even just, “Thank you, I’m going to be with the woman until help arrives, goodby” after giving the address but continued talking away, and saying she could not give CPR and would not give someone else the phone. Very bad . IMO. </p>
<p>Now the facility is saying what this person said is untrue. So we shall see.</p>
<p>Yes, the call was disturbing. Her vocal “affect” seemed very flat; there was no discernible distress, no apparent moral dilemma or any hint of ambivalence about the situation. </p>
<p>At first the administration backed her up, but now they seem to be backpedaling a bit. It will indeed be interesting to see how this plays out.</p>
<p>Very well said, kluge. (#122)</p>
<p>Though I agree with what Kluge has said in post 122, I want to point out that there are a number of elderly, in their 80s 90s, who do want the fulll efforts made as they still want to live. There are also many who have illnesses, conditions, handicaps that want to live too. Whether someone is to be given treatment, CPR, drastic means is not a decision to be made just on factors such as age, and other such factors. Presuming such things is insulting to those who have the right to make up their own minds that way. My MIL’s aunt lived to 104 and until the last 2 years of her life was quite active and aware, making her own decisions and running things as she was 30 year before that. My MIL’s cousins are in their 90s and they still drive, long distances even and, can hold their own with many who are much younger. No senility or dementia there. To presume that these folks would not want CPR or drastic measure to extend their lives would be doing them a disservice and, I think, illegal… No DNRs for them. </p>
<p>It is scary when someone disabled or old or both is hospitalized, DH’s unclue is in his 80s, still works a four hour day and cooks dinner, is active with family and totlaly together. But, he is on oxygen, the full amount and if he gets a cold, which he does every winter (not yet this year!), he has had to be vented which is a trauma that he fights terrible when it is done. A couple of years ago, he was discussing this with a staff member, his fear his terror, his hatred fo the vent. And how he has to be weaned off of it. The next thing he knew there was an ethics meeting being held and they had documents for him ot sign a DNR so that he would never have to be vented again! Which would mean the end of him. I don’t think they would have moved so fast for someone younger</p>
<p>There is a blog called “The Bad Cripple” written by a professor at a nearby college who is disabled. He tells terrible tales of what his experiences are in a hospital and that it is always a fear of those who are disabled that treatment will not be given on the same basis. And a real fear, with the experiences he has undergone. He is a paraplegiic who works full time, was married, has a college aged son, and is very active in life. That others, particularly in the medical field have indicated that his life is not so full or that he should not get full treatment due to his disabilities has angered and frightened him. </p>
<p>So these decisions have to be made by a cognisant person at a time when they are able to focus at the issues at hand, and not be made by others who presume a lesser quality of life because they believe it is so due to age or infirmity. We cannot let others presume because erring that way can mean the loss of a life because it is presumed less valuable.</p>
<p>I think about that 90 year old French woman who sold her condo to a man about 30 years her junior in Paris, with the right to remain in it till she died. She outlived him, and did not die for another 20 years. Statistical outlers, yes, but you never know who is one.</p>
<p>So the idea of drastic treatments, CPR, all of these decisions should be for life when they have to be made on the spur of the moment, and have not been conveyed and documented at a calmer time when all can think about the ramifications. It’s a final step to not intervene, whereas future treatments may be withheld if the decision is made during the calm that the next storm should be the one to take the person away.</p>
<p>Well said, cpt. I think I need a new advanced directive.</p>
<p>Didn’t an article up thread say she specifically CHOSE this facility BECAUSE of this policy? In which case, the nurse absolutely did the right thing. Comparing her to any other elderly person is useless because this is what she wanted.</p>
<p>^ Yes and no. The family said that she was aware of the policy, although I find it very hard to believe that most reasonable people would interpret “not licenced to provide medical care” as “are prohibited from responding to emergencies routinely handled by laypeople even when explicitly instructed to do so by a 9-11 operator.”</p>
<p>They also said that she had chosen independent living over assisted living/nursing home care, but that means very little; almost everyone, given the choice, would rather live in what is essentially a senior apartment complex than the hospital-like setting of even an assisted living facility, let alone a nursing home. </p>
<p>In this case, maybe the woman would have preferred not to be given CPR - although, in the absence of a DNR, we can’t come close to assuming that. Heck, given the statistics some people are giving in this thread on CPR and the elderly, maybe the medical community should reevaluate their protocols, not because of eugenics, but because CPR isn’t actually effective on people of a certain age/health. But the fact remains that the “nurse” refused to give care, not because she was respecting the elderly woman’s wishes or because she had reasonable doubts about the efficacy of CPR in this particular case, but because she believed, correctly or incorrectly, that a policy prohibited her from doing so. And that’s inexcusable.</p>