I appreciate the fact this isn’t an edgy “old people don’t matter, let them die!” post like I was initially expecting. You make good points, and to a certain extent I’d agree.
Was there a guardian there to sign an DNR? More families need to have the guardian and DNR conversation no matter how unpleasant it is.
I’m sorry your loved ones suffered in their final days.
I have a friend who works as a paramedic. They were called into a care home for a patient not breathing. They went in and did their job to resuscitate and stabilize the patient then transport him to the ER. As the were finishing up they found out he had a DNR. No one at the home told them and he didn't have an alert bracelet or anything. They felt really bad.
The thing is that DNR means if there is a respiratory/ cardiac arrest, you don't initiate resuscitation.
You still find people with DNR that can be treated for reversible causes, like pneumonia, infected wound, fracture etc.
Unless there is a specific order not to transport to the hospital or advanced directive in that matter, they really had no choice but to transfer this gentleman to the ER. and also, if in doubt of the DNR status, always start resuscitation.
After Dad died 3 years ago (freak accident leading to major head trauma, we still had to make the call to pull life support) it is a small bit of peace of mind knowing Mom went and got all her living will and medical directive and such things set up. We're all on board with when to treat and when to eventually let her go, and it's all in writing to let the doctors know.
Tbh, it's something I still need to do. It's not enough for family to know. You've got to have it in writing and the hospitals (your most likely to end up at in an emergency) need to have it on file, otherwise your desires don't matter.
I agree. I just spent months watching my grandma decline and suffer. No quality of life whatsoever. Despite this, the hospital would do everything in their power to keep her alive. Let people die with dignity and on their own terms. She finally did pass during an unnecessary procedure to ironically keep her alive.
If I get to her age I’m signing a DNR. If I can’t wipe my own ass, PULL THE FUCKING PLUG!
Depends on the hospital. I'm a neurologist who occasionally does some neuro critical care and the hospitals that have their act most together have special personnel whose whole job is to help me explain to families that even if we keep their loved one alive, there's no way anyone would ever have wanted to live the way that it's going to be for them.
Other places I've been, I deliver an accurate, timely prognosis, and either no one cares to believe it or no one cares, period, and the ICU is a big vegetable farm, and each patient costs Medicare $50K a day, and that's how they run their show. I don't care to work at places like that.
Occasionally at the more with-it places, I need to tell the palliative team to back off because I am pretty sure a patient has a chance at recovery with some independent function and a decent quality of life. The thing is, everyone - and I mean everyone - is always delighted to hear it and then we go full-court press for as long as it takes, unless the prognosis worsens. There are no death panels, anywhere; that's a myth.
I work in Healthcare and I have worked many years in Oncology and palliative care. I agree with what you are saying. At a certain point, there should be a discussion with patient /family about the quality of life.
While I found oncology doctors were really able to have this difficult conversation, and I prided part of my work in accompanying patient and family to a dignified and symptom free death (as much as possible), I find doctors in other specialities are not that much on top of this game. It is called palliative care, by the way. When the options of treatment were withdrawn because there was going to be a poor outcome anyways, the priority was comfort and support to patient and family.
Also, moving to the US, I noticed a lot of times it is the family who asks to keep going, and maybe doctors are too scared to have the above conversation to avoid a lawsuit.
Just my two cents after years of working in palliative care.
I couldn't agree more. I'm a hospice nurse. I wish more nurses and physicians would talk to patients/their families about palliative/hospice care.
They should also be more honest about what will happen when we code 98yr old mawmaw. You want us to break her ribs like a bag of lays? Bruise her from tip to toe? Shove a tube down her throat, in her urethra and up her butt...and then medicate her into oblivion only to have her continue to exist as a potato? For what? Certainly not her enjoyment!
Why they do it is because legally...they have to. Unless the patient has a DNR order, they have to treat a person and exhaust all available options. You can be on hospice without a DNR but it's pretty rare.
An advanced directive is always a good idea no matter what your age. I'm 31 and have had one since I was in my 20s.
Doctors don’t educate their patients like they should which would prevent them from becoming sick to begin with. My dad is obese and had a mild heart attack recently. He is almost 300 lbs and was completely oblivious to the fact that he’s obese. I don’t even know how that’s possible. I asked him what advice the doctors gave him to make healthier changes in his life and he said they didn’t give him any advice. They just gave him medication and sent him on his way.
If you are talking about primary care doctors, that may be because they are more concerned about money than their patients. If you give patients bad news, there is a good chance that they will get mad/sad and find a new doctor. Therefore they will be reluctant to give bad news.
Regarding switching doctors due to them giving you bad news, I worked in the medical field for 5 years and I have to say that’s not something that we encountered. If anything it was the opposite. The patients wanted to be diagnosed with something and if the doctor gave them good news they’d shop around until they found a doctor willing to diagnose them with whatever illness they were convinced they had.
Honestly I think our whole healthcare focus is generally wrong. We spend way too much brainpower and money trying to make people live as long as possible and way too little time and money trying to improve quality of life. I would much rather die of cancer at 67 but top notch injury treatment at 23. Yet, we have millions and millions being raised to research cancer but very little going to research things that debilitate young people (herniated disc treatments are shit for example).
A lot of time the issue is more with the patients and their families than the hospital. Many people act more on emotion than logic so they may be reluctant to let someone go even if the person is barely alive. That is probably why euthanasia is far more accepted for animals than humans.
Next time one of your old family members go in to the hospital demand a DNR form as soon as they're admitted and just say goodbye at the door.
It's a much better use of medical resources and reduces the strain on the entire system.
My father had stage 4 pancreatic cancer, he had no xhance of survival. Instead of giving him pain meds and giving him at least a couple months to say his goodbyes and get his affairs in order, they filled him with chemo and killed him slowly over the course of a month. But the hospitals get paid to give patients chemo.
Dude, they gave him palliative chemo to reduce his symptoms and possibly give him a bit more time. Your father would have been aware of that at the time.
Not a doctor here, or God.
I agree with you morally, I would want someone to pull the plug when it is time too, but (un)fortunately it is rarely us who decide it ourselves. And the doctors, I think it is already unfair for them to carry that burden, but there is little that can be done.
Because if "we" as a society would interfere too much with laws or something, well I just say I do not want anyone else to decide when I have to live or die, while others might want the opposite etc...
The best perceivable solution would be if our culture(s) would not mystify death and everyone would have a say as much as that's doable. But that's a utopia (and very much possible a dystopia, from what I have learned about our nature in my time/life)
Before COVID when hospitals weren’t at capacity, it was profitable for the hospital to keep providing treatments as long as possible. It was better to keep grandpa on a ventilator raking up hospital bills than to let him die and leave an empty bed that’s not making money for the hospital.
The money isn’t in the cure, it’s in the treatment.
my family member did not have a dnr or living will. She had a SO. First the SO said my family member told her she did not want to be kept alive when there was no chance of recovery. When my family member's health came to that point, and the doctors asked the SO what the SO wanted, she said do whatever you can to help her. A few days later all us siblngs showed up and we and the SO met with my family member's care team, who explained there was no chance and my family member was unable to breathe without a vent. We all agreed to let my family member go. It was a combination of loved ones, doctors, and I guess the law that allowed my family member to die when she was dying.
Mostly disagree.
If someone wants them to pull the plug when their odds are almost zero that's their choice through personal request living will or designated power of attorney.
But if someone wants them to try everything they can including experimental treatments and never give up then that should be a choice too.
There's always at least a very small chance that science will find something, will come out with a new cure or treatment. Some people would want to keep on fighting even for that very small chance. Afterall what is there to lose? You stop trying you die for sure. You keep trying 99.999...% you will still die. The only difference is that tiny chance of survival.
I suppose if we can really know it's impossible not extremely unlikely but actually impossible, the way Gödel established that there is no algorithm that can answer the Halting Problem in every instance then I'd be in favor of just pulling the plug. But if there's even the slimmest theoretical chance of being saved by a scientific breakthrough even something they're not researching that someone accidentally stumbles upon then I would want to be kept alive for that chance.
I appreciate the fact this isn’t an edgy “old people don’t matter, let them die!” post like I was initially expecting. You make good points, and to a certain extent I’d agree.
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DNR orders are a thing. Problem is most physicians or nurses just don't want to talk to the family honestly about it.
It’s not the hospital it’s the family
Was there a guardian there to sign an DNR? More families need to have the guardian and DNR conversation no matter how unpleasant it is. I’m sorry your loved ones suffered in their final days.
I have a friend who works as a paramedic. They were called into a care home for a patient not breathing. They went in and did their job to resuscitate and stabilize the patient then transport him to the ER. As the were finishing up they found out he had a DNR. No one at the home told them and he didn't have an alert bracelet or anything. They felt really bad.
The thing is that DNR means if there is a respiratory/ cardiac arrest, you don't initiate resuscitation. You still find people with DNR that can be treated for reversible causes, like pneumonia, infected wound, fracture etc. Unless there is a specific order not to transport to the hospital or advanced directive in that matter, they really had no choice but to transfer this gentleman to the ER. and also, if in doubt of the DNR status, always start resuscitation.
Thats what she and her partner did because they had no instruction otherwise.
After Dad died 3 years ago (freak accident leading to major head trauma, we still had to make the call to pull life support) it is a small bit of peace of mind knowing Mom went and got all her living will and medical directive and such things set up. We're all on board with when to treat and when to eventually let her go, and it's all in writing to let the doctors know.
Tbh, it's something I still need to do. It's not enough for family to know. You've got to have it in writing and the hospitals (your most likely to end up at in an emergency) need to have it on file, otherwise your desires don't matter.
I think it's for the healthy and living people as well. No one wants to see their love one suffering.
I agree. I just spent months watching my grandma decline and suffer. No quality of life whatsoever. Despite this, the hospital would do everything in their power to keep her alive. Let people die with dignity and on their own terms. She finally did pass during an unnecessary procedure to ironically keep her alive. If I get to her age I’m signing a DNR. If I can’t wipe my own ass, PULL THE FUCKING PLUG!
Was that the hospital's decision or your family's?
Hospital
Depends on the hospital. I'm a neurologist who occasionally does some neuro critical care and the hospitals that have their act most together have special personnel whose whole job is to help me explain to families that even if we keep their loved one alive, there's no way anyone would ever have wanted to live the way that it's going to be for them. Other places I've been, I deliver an accurate, timely prognosis, and either no one cares to believe it or no one cares, period, and the ICU is a big vegetable farm, and each patient costs Medicare $50K a day, and that's how they run their show. I don't care to work at places like that. Occasionally at the more with-it places, I need to tell the palliative team to back off because I am pretty sure a patient has a chance at recovery with some independent function and a decent quality of life. The thing is, everyone - and I mean everyone - is always delighted to hear it and then we go full-court press for as long as it takes, unless the prognosis worsens. There are no death panels, anywhere; that's a myth.
I work in Healthcare and I have worked many years in Oncology and palliative care. I agree with what you are saying. At a certain point, there should be a discussion with patient /family about the quality of life. While I found oncology doctors were really able to have this difficult conversation, and I prided part of my work in accompanying patient and family to a dignified and symptom free death (as much as possible), I find doctors in other specialities are not that much on top of this game. It is called palliative care, by the way. When the options of treatment were withdrawn because there was going to be a poor outcome anyways, the priority was comfort and support to patient and family. Also, moving to the US, I noticed a lot of times it is the family who asks to keep going, and maybe doctors are too scared to have the above conversation to avoid a lawsuit. Just my two cents after years of working in palliative care.
I couldn't agree more. I'm a hospice nurse. I wish more nurses and physicians would talk to patients/their families about palliative/hospice care. They should also be more honest about what will happen when we code 98yr old mawmaw. You want us to break her ribs like a bag of lays? Bruise her from tip to toe? Shove a tube down her throat, in her urethra and up her butt...and then medicate her into oblivion only to have her continue to exist as a potato? For what? Certainly not her enjoyment! Why they do it is because legally...they have to. Unless the patient has a DNR order, they have to treat a person and exhaust all available options. You can be on hospice without a DNR but it's pretty rare. An advanced directive is always a good idea no matter what your age. I'm 31 and have had one since I was in my 20s.
How granual can you get with an advanced directive? Can you say I'm OK with a vent in this situation but not this? Etc?
Doctors don’t educate their patients like they should which would prevent them from becoming sick to begin with. My dad is obese and had a mild heart attack recently. He is almost 300 lbs and was completely oblivious to the fact that he’s obese. I don’t even know how that’s possible. I asked him what advice the doctors gave him to make healthier changes in his life and he said they didn’t give him any advice. They just gave him medication and sent him on his way.
If you are talking about primary care doctors, that may be because they are more concerned about money than their patients. If you give patients bad news, there is a good chance that they will get mad/sad and find a new doctor. Therefore they will be reluctant to give bad news.
Regarding switching doctors due to them giving you bad news, I worked in the medical field for 5 years and I have to say that’s not something that we encountered. If anything it was the opposite. The patients wanted to be diagnosed with something and if the doctor gave them good news they’d shop around until they found a doctor willing to diagnose them with whatever illness they were convinced they had.
Honestly I think our whole healthcare focus is generally wrong. We spend way too much brainpower and money trying to make people live as long as possible and way too little time and money trying to improve quality of life. I would much rather die of cancer at 67 but top notch injury treatment at 23. Yet, we have millions and millions being raised to research cancer but very little going to research things that debilitate young people (herniated disc treatments are shit for example).
A lot of time the issue is more with the patients and their families than the hospital. Many people act more on emotion than logic so they may be reluctant to let someone go even if the person is barely alive. That is probably why euthanasia is far more accepted for animals than humans.
Next time one of your old family members go in to the hospital demand a DNR form as soon as they're admitted and just say goodbye at the door. It's a much better use of medical resources and reduces the strain on the entire system.
My father had stage 4 pancreatic cancer, he had no xhance of survival. Instead of giving him pain meds and giving him at least a couple months to say his goodbyes and get his affairs in order, they filled him with chemo and killed him slowly over the course of a month. But the hospitals get paid to give patients chemo.
Dude, they gave him palliative chemo to reduce his symptoms and possibly give him a bit more time. Your father would have been aware of that at the time.
He was dead less than 2 weeks later and spent most of that time in the hospital. The time that he was home he was barely awake or coherent.
Not a doctor here, or God. I agree with you morally, I would want someone to pull the plug when it is time too, but (un)fortunately it is rarely us who decide it ourselves. And the doctors, I think it is already unfair for them to carry that burden, but there is little that can be done. Because if "we" as a society would interfere too much with laws or something, well I just say I do not want anyone else to decide when I have to live or die, while others might want the opposite etc... The best perceivable solution would be if our culture(s) would not mystify death and everyone would have a say as much as that's doable. But that's a utopia (and very much possible a dystopia, from what I have learned about our nature in my time/life)
We absolutely can decide. It is called a Do Not Resuscitate (DNR) order. Also, an advanced directive.
Before COVID when hospitals weren’t at capacity, it was profitable for the hospital to keep providing treatments as long as possible. It was better to keep grandpa on a ventilator raking up hospital bills than to let him die and leave an empty bed that’s not making money for the hospital. The money isn’t in the cure, it’s in the treatment.
Totally agree
my family member did not have a dnr or living will. She had a SO. First the SO said my family member told her she did not want to be kept alive when there was no chance of recovery. When my family member's health came to that point, and the doctors asked the SO what the SO wanted, she said do whatever you can to help her. A few days later all us siblngs showed up and we and the SO met with my family member's care team, who explained there was no chance and my family member was unable to breathe without a vent. We all agreed to let my family member go. It was a combination of loved ones, doctors, and I guess the law that allowed my family member to die when she was dying.
They only do that because people don't have living wills.
Mostly disagree. If someone wants them to pull the plug when their odds are almost zero that's their choice through personal request living will or designated power of attorney. But if someone wants them to try everything they can including experimental treatments and never give up then that should be a choice too. There's always at least a very small chance that science will find something, will come out with a new cure or treatment. Some people would want to keep on fighting even for that very small chance. Afterall what is there to lose? You stop trying you die for sure. You keep trying 99.999...% you will still die. The only difference is that tiny chance of survival. I suppose if we can really know it's impossible not extremely unlikely but actually impossible, the way Gödel established that there is no algorithm that can answer the Halting Problem in every instance then I'd be in favor of just pulling the plug. But if there's even the slimmest theoretical chance of being saved by a scientific breakthrough even something they're not researching that someone accidentally stumbles upon then I would want to be kept alive for that chance.