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Do Not Resuscitate Orders

DNR's. In Illinois, two are required. Most people don't know that. And the consequences of not knowing can be considerable. Maybe your state requires two as well.


  1. A Standard Healthcare Power of Attorney for family to present at the hospital.
  2. A special DNR order to present to paramedics when 911 is called.

Without that second one, if a loved one's heart stops beating, the paramedics will ALWAYS attempt resuscitation, no matter what you say to them as their HCPOA. It is signed by the person (or their spokesperson) and by that person's doctor.

I was interviewing a company that provides private companionship (and other services) for seniors in their home. The company representative asked me if I had that special DNR order on my mom. Right in front of her. I was flabbergasted.

I guess she couldn't know that mom has dementia and that I've taken over her healthcare decisions, but I would have expected that question to be asked privately. My answer to her was that she didn't need that information, and she could clearly see I was uncomfortable. The whole thing went right over mom's lil' head.

What are your thoughts? Should she have asked me privately?

Hi Maggie - from my perspective, the representative was in effect asking your mom the question through you - if she didn't know that you have power of attorney and other authority over your mom's care, she would be negligent asking you and not asking her and getting the answer from her.

I never had power of attorney for my mom, but here and with my mom's condition, every healthcare and homecare representative I ever came into contact with took my word as the final word for any medical or personal treatment or non-treatment. Even in hospitals, whatever I said was taken as the final word. Every time my mom was in hospital, they had me fill out a form related to the extent to which the hospital would resuscitate her in various scenarios. The day my mom died, in hospital, the doctor told me how she was and her chances of surviving and indicated that if she started to die they could resuscitate her but it could cause her great discomfort, broken bones, etc. and I simply told the doctor that she had lived a long life and at 96 I didn't want her to be brutalized in order to keep her alive a few minutes/hours/days longer and we should just let her pass in peace - and she did, overnight, and I've never regretted how it ended.

Perhaps in the US things would be much different with all the lawsuits filed against hospitals and healthcare professionals, but I had a fairly lengthy history with the hospital for my dad and then my mom so it was never a problem and they knew they could trust me.
 
I guess she couldn't know that mom has dementia and that I've taken over her healthcare decisions, but I would have expected that question to be asked privately. My answer to her was that she didn't need that information, and she could clearly see I was uncomfortable. The whole thing went right over mom's lil' head.

What are your thoughts? Should she have asked me privately?

If I were interviewing a patient, and did not know that they had dementia, then I would certainly ask the patient about DNR orders. If it were obvious that she had dementia, I would not ask directly, but would ask in a roundabout way. It is always the patient's wishes which take precedence in health care decisions, unless they are obviously unable to make those choices.
 
If I were interviewing a patient, and did not know that they had dementia, then I would certainly ask the patient about DNR orders. If it were obvious that she had dementia, I would not ask directly, but would ask in a roundabout way. It is always the patient's wishes which take precedence in health care decisions, unless they are obviously unable to make those choices.
I agree with what you said, but you and me originally and many others seem to be missing a KEY point. The health care professional was not interviewing a patient, it was the opposite. The patient through and with her daughter were interviewing a caregiving agency. With that in mind, that question is unnecessary to be asked unless and until an enrollment with that agency/facility is actually being initiated. At which time, things like the power of atty and any known DNRs would be presented and discussed appropriately with a non-salesperson, one who actually does the work and knows the rules and how better to handle situations as described.
 
Actually yes. I do believe that. If someone's state of mind is to the point that they want to be allowed to die, who is anyone to argue with what their state of mind does to them. Contrarily if someone just wants to keep living, regardless of their state of mind, seriously, you'd just let 'em die? Again, if we're talking that the same person during "sane" moments prepared for the concept that they may not remain sane and provided either a dnr or it's alternative, then that's different. But if we are starting at neutral, yeah, reagardless of what a daughter thinks or a son or a lawyer thinks, a person's desire regarding DNR or not-DNR should be honored.

In no reference at all to Maggie, not all caregivers who have power of medical atty are good people with the patient's wishes as their own, y'know. Many see a certain cost benefit to DNRs, if nothing else.

I understand and even know that, my grandfather suffered as did my best friend's father, so I totally realize. Then I guess I would have to amend to say that given our current society, better to err on the side of non-DNR. Again, this is assuming that no DNR was created when the person was still lucid.

Rephrasing for clarity... I guess I'm saying that if a DNR is not presented prior to losing lucidity, no one who is subsequently given power of atty should be able to initialize one. Contrarily, if one was issued, it should not be able to be revoked by a person with power of atty.

Mom executed her Health Care Power of Attorney twenty years ago. She made her wishes known. She made the sensible decisions MOST of us would make re when to keep trying and when to stop. So there it is...clear as day. It stayed in my file cabinet for years. Two years ago, I began giving them out to all of her doctors and took over her medical decisions at that time, with her blessing. I went to most of her doctor visits with her and had instructions on file that any medication changes were to be discussed with her (of course), but absolutely HAD to be discussed with me in a brief phone call from a nurse or doctor. This because she was very confused and didn't remember what doctors said.

How did I know to do that? When she began missing appointments, when I found her pillbox with pills not taken, and, finally, when she cut up eight $100 bills and threw them in the garbage...having no recollection at all that she'd done so.

In our discussions throughout the years, she's told me, "Maggie, if I'm going to die, I don't want to know." I'll honor that wish. In the case of her most serious brush with death (about three/four weeks ago), I never told her how sick she was . . . why would I do that? . . . And never told her I was considering enrolling her into the hospice program . . . why would I do that either?

There are decisions we simply MUST be willing to make for our loved ones . . . like when is it time to "go home." If I asked my mother right now if she wanted a DNR, I'm not sure what she'd say; but ten years ago, she gave me her full vote of confidence that whatever I thought was best was what she wanted. *shrug*

***********

I really appreciate all the great comments on this thread. I walked outside with the lady and told her I had what she'd asked about in place and also the formal HCPOA that is recognized by doctors and hospitals. (The special one is what's needed for 911 calls.) Had mom been "her old self" ("young self" ha!) she might have questioned what the representative asked. As it was? I don't think she had a clue what she was talking about. But it surprised me that her FIRST question wasn't, "Do you have her healthcare power of attorney?" and next, "Do you have instructions for paramedics in case our caregiver has to call 911?" (I think that would have been a better way to handle it.

For those who don't know, the paramedic DNR requires a doctor's signature. She's been going to the same doctor for 12 years or so.

My prayers for my mom include her going to sleep and not waking up. If I am home, I will wait a considerable amount of time before I even call 911. Usually? It's not "death" we fear -- it's the journey. I hope and pray hers is a pleasant one. She's 86 years old, can barely walk, has congestive heart failure. When her little body gives up, I don't intend to use mechanical means to interrupt her journey. One cannot put that responsibility onto a caregiver who is a complete stranger.

I love my mom with all my heart. She gave me life after all. And she trusts me to the right thing by her until the end. I will.

Thank you all.
 
Dunno if this has been asked yet or not, but can a DNR be put in place if the patient is not of sound mind? I thought an affidavit had to be signed, and the person be of sound mind before they could make such a strong decision.
 
I understand and even know that, my grandfather suffered as did my best friend's father, so I totally realize. Then I guess I would have to amend to say that given our current society, better to err on the side of non-DNR. Again, this is assuming that no DNR was created when the person was still lucid.

Rephrasing for clarity... I guess I'm saying that if a DNR is not presented prior to losing lucidity, no one who is subsequently given power of atty should be able to initialize one. Contrarily, if one was issued, it should not be able to be revoked by a person with power of atty.

Though I disagree, I recognize that it's a difficult issue and one without a clear answer. It's obvious that you've thought about it and are guided by what you think is best under the circumstances. I don't want to derail Maggie's thread, so I'll leave it at that
 
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