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DNR’s are not unheard of these days and some people do in fact make this a legal and binding bill of order. On the medicine wards, you will come across patients who have a "Do-Not-Resuscitate" order on their chart. You will also be in situations where you are asked to discuss with a patient whether they want to or should have resuscitation following a cardiac arrest or life-threatening arrhythmia. Like many other medical decisions, deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest involves a careful consideration of the potential likelihood for clinical benefit with the patient's preferences for the intervention and its likely outcome. Decisions to forego cardiac resuscitation are often difficult because of real or perceived differences in these two considerations.

When can CPR be withheld? Virtually all hospitals have policies which describe circumstances under which CPR can be withheld. Two general situations arise which justify withholding CPR:

When CPR is judged to be of no medical benefit (also known as "medical futility"; see below), and

When the patient with intact decision making capacity (or when lacking such capacity, someone designated to make decisions for them) clearly indicates that he / she does not want CPR, should the need arise.

When is CPR not of benefit? One approach to defining benefit examines the probability of an intervention leading to a desirable outcome. CPR has been prospectively evaluated in a wide variety of clinical situations. Knowledge of the probability of success with CPR could be used to determine its futility. For instance, CPR has been shown to be have a 0% probability of success in the following clinical circumstances: Septic shock, Acute stroke, Metastatic cancer, Severe pneumonia, In other clinical situations, survival from CPR is extremely limited: Hypotension (2% survival), Renal failure (3%), AIDS (2%), Homebound lifestyle (4%), Age greater than 70 (4% survival to discharge from hospital)

Who is the only one (s) that can change this order? Legal guardian with health care decision-making authority >> Individual given durable power of attorney for health care decisions >> Spouse >> Adult children of patient (all in agreement) >> Parents of patient >> Adult siblings of patient (all in agreement)

When does this become a violation? A physician is prohibited by the bill from willfully failing to follow the procedures for transferring a patient who possesses DNR identification but whose attending physician is unable or unwilling to follow the do-not-resuscitate protocol for the person. The bill also prohibits anyone who has personal knowledge that another person has revoked a do-not-resuscitate order or personal knowledge that a physician has issued an order that supersedes a previous do-not-resuscitate order from purposely concealing or withholding that information in order to cause the use or withholding of CPR. Violators are guilty of a misdemeanor of the third degree.

This happened to my friend who was married to my Cherokee Sister. My Sister died 2 ½ years ago from heart failure in her sleep at her happiest moment which is the way most people would prefer to go. The only closest family left to argue any DNR would be me. But I was never notified! Even if I was, I would never go against his decision anyway!

Here’s what happened…..Blaine ~ (Two Snakes) legally had a DNR order done up following his open heart surgery which happened a year after Cindy’s (White Hawk) death! He suffered a massive heart attack which placed him on the operating table. While on the table, they made a big mistake and over dosed him causing his heart to stop! To cover up their mistake they violated his DNR order and resuscitated him. Now he suffers with heart beating and pounding like crazy often causing him a great deal of pain which I noticed would happen about every ten to fifth teen minutes. He was really mad that they violated him like that because he doesn’t care to live in such a manner. The doctor told him when they released him to get his affairs in order which was the reason for my trip up which I had to take. After he explained to me what happened and knowing and seeing what he now has to go through….He had every right to be upset! Although he has been given the chance that most do not get, to make sure everything is in order for his death, no one should be placed or forced into a situation of continuous pain and agony! It hurt to see him suffer all the intense attacks which can not be prevented until his actual death!

What would you do? Would you argue anyone’s DNR right? Do you think doctors should be allowed to violate this right by any means they deem necessary? What do you think about this?

GET-R-DONE

Mater

'GET-R-DUN'

"Do-Not-Resuscitate" DNR Orders

Mater01

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