My uncle had a Living Will when he was admitted to hospital with pneumonia. I know he did not want any heroics but when his heart suddenly stopped they did CPR which revived him for a few days on a ventilator until he died. Why did the hospital do CPR when he had a Living Will stating not to?
Living Wills, or Advance Directives, are legal papers which tell others what you want done regarding your healthcare should you not be able to tell them. For example, if you were to have a stroke or become so sick you could not communicate clearly, and you were at risk of dying, your Advance Directive can be used to guide decisions regarding CPR [CardioPulmonary Resuscitation], feeding tubes, a ventilator, or even whether to use antibiotics and IV fluids.
Some states have a specific question on their Advance Directives regarding CPR but unfortunately Alabama does not (you must write on Alabama’s form that you DO NOT want CPR). The POLST [Physician Order for Life Sustaining Treatment] is a newer type of Living Will used in several states: if you choose “No CPR”, once signed by the doctor, it is valid anywhere in that State, whether in an ambulance or if admitted to hospital or nursing home—you do not need another doctor order.
However, in Alabama, even if you wrote No CPR in your Living Will, you must still have a doctor’s order for No CPR [meaning AND/DNR – Allow Natural Death/ Do Not Resuscitate] when admitted to hospital or nursing home. Otherwise the staff will do CPR if your heart stops.
Why have an AND/DNR order written on admission to hospital or nursing home? Because:
• CPR rarely works: TV is misleading: studies found TV suggests 67% of people survive. Reality is 0 (nursing home) and sometimes up to 17% (hospital); but many survivors testify they wish they had not been resuscitated.
• CPR is a harsh procedure incompatible with a peaceful death; it offers only false hope when everyone should be preparing for this final stage of life. Physicians and families have asked why I’m so against CPR: it’s because it rarely works [ask nurses/doctors who have had to do it often] and the few times it “succeeds” only adds to prolonging suffering (for both patient and family!).
• Although most seniors will develop signs of approaching death, allowing an opportunity for the doctor to write an AND/DNR order, many collapse without warning, resulting in unwanted CPR.
• Seniors with life-limiting illnesses do not want the dying process prolonged. Most tell me, “when my heart stops, just let me go”. They want to be kept comfortable, to be listened to, and to be part of the decision-making process.
Patients expect their physician to discuss end-of-life issues with them and respect their choice; if that isn’t happening or if patients/families are still confused what to do, our hospice can help you work through these issues.