DNR

Many times over the years I have had end-of life discussions with patients and their family members. It's always painful, sometimes more so than others.

Some, a few, patients have thought about what they want and have conveyed their wishes to their loved ones. And their loved ones have agreed to respect their wishes. Some want everything done for as long as possible, others want little or nothing done, most are in the middle. There is no right decision, just your decision.

At the end of life we frequently we run into the family where everyone, except one family member, agrees to stop treatment and that one insists that every thing be done, even when told it's medically futile. Even when told it's not what the patient wants. This creates a lot of problems and tensions within the family, but also with the medical staff. If we don't know the patient and aren't familiar with their wishes we are going to listen to the one who wants everything done. Unless there is a clear consensus or a legally designated Medical Power of Attorney, we will do everything.

Other times, we have patients who are ready to stop. They've gone through treatments and surgeries and radiation and still have cancer and they are weary and just want to quit, but don't want to disappoint their family.

I have had family members ask if their loved one could be put on a ventilator or frozen until we find a cure for their disease.

I have seen people refuse care that could have saved a patient in the mistaken belief that the patient would absolutely not want to be put on a ventilator, and I have seen patients tortured for days and sometimes weeks prior to dying because their family members could not make themselves give up.

End of life discussions are fraught with emotional landmines, but the subject shouldn't be avoided. Talk to your family, your spouse, kids, siblings, parents. Please make clear to them how you feel, they shouldn't be expected to guess. Allow them to be comfortable in the thought that they are doing what you want.

In several states whether a DNR (Do Not Resuscitate) order is given or not family members are asked to sign a statement saying that they firmly believe this is what the patient would want. If you don't tell them, how can they know?