My father died Friday. His instructions were ‘Do Not Resuscitate’ as his biggest fear was a painful, lingering death as both his parents suffered. In an emergency room, doctors will do whatever they have to save a life. This is a good thing, except when prolonging life means tubes, pain, morphine, and no expectation of returning to anything close to normalcy for the patient, and may only prolong life for a few weeks.
My father had internal bleeding (among other things.) Doctors told my sister they wanted to do a colonoscopy to determine where the bleeding was from. She said “Palliative care only.” They understood and walked out of the room. There absolutely are times when a colonoscopy in such situations might save a life. This was not one of them. My dad was almost 96. The causes of death on the death certificate was “cardiac arrest, sepsis, internal bleeding, health-care induced pneumonia.” The pneumonia was actually a nasty GI bug from the excellent skilled nursing facility he was in. (They gave him superb care, outbreaks happen in hospitals.)
In one of those odd coincidences of life, his niece who was eleven years younger (they were lifelong friends), died a few hours before him. She had been confined to a hospital bed for weeks. Her health was failing. She was a MD so had no illusions. Because she had given clear directives, the time came when the pain became too much. She told the doctor to give her morphine and pull out the plugs. She was dead in 30 minutes.
Such directives need to be carefully thought out. The vast majority of the time heroic measures should certainly be taken. However, when it’s clearly end of life, with the patient express instructions, Do Not Resuscitate should be an option.