End of Life and "Do Not (Attempt) Resuscitation" thoughts...

Friends:

Good Monday morning! I hope that your collective weekends brought you outside in the Spring to interact with the natural beauty that surrounds us this time of year.

I was struck this morning by a National Public Radio (NPR) piece entitled, "For This Doctor, DNR Means 'Do Not Resign'" (see at: http://www.npr.org/templates/story/story.php?storyId=125788057&ps=cprs). The reflections of this young-ish physician are all too common, and one that I dealt with mcuh of the time that I practiced in intensive care units (ICU). Persons arrive at Emergency Departments (ED) without all their relevant information (whether from home or all too often from nursing homes) and the medical mantra of "let's do everything" kicks in. Persons are physiologically stabilized and then sent to the ICU where often discussions with the support system reverses what was done in the ED.

This kind of behavior is understandable (medical model of err on the side of life) but creates hard feelings among medical practitioners (as you can hear in this physician's lament). Hear also, however, that the young doctor hits on many of the "ills" that are so imbedded in our current model of delivery of "care". Comments like "she's fixable in the short-term", "I think she can probably get at least a few good weeks", "here are my educated instructions". Note how his focus is on him - not on the person he is treating. Now, in fairness, he has no relatinoship with the person in question here - the first time he meets her he has to perform heroic measures in order to "save" her life. Thus, he doesn't know what she wants and his "education" and professional ethic takes precedence.

At one point in time, a physician had the luxury of knowing his or her patients from cradle to grave - in fact, in some cases, for many generations. This is by far the exception rather than the rule nowadays. Doctors do not have the kind of in-depth conversations about wishes and end-of-life scenarios that would keep this kind of intervention (bordering on abuse) from happening. It is uncomfortable to have a plastic tube inserted into your esophagus; it is uncomfortable to have air blown into and sucked out of your lungs by a machine; it is uncomfortable and debilitating to have hemodialysis; it is painful to have chest compressions and IV starts, constant blood draws, not to mention laying in a hospital bed; it is annoying beyond belief to have constant noise of monitors and hospital personnel.

Not only that, but after all these things were done to this unfortunate soul - one of God's children like all of us, she was still going to die. Remember this educated physician stated that "she can probably get at least a few good weeks". The operative word is "good" - what does that mean spiritually? Our Hippocratic Oath requires all healthcare professionals to "first do no harm" - first and foremost we should not harm another person! As detailed in the previous paragraph, much of what we do nowadays does in fact harm people (that is without considering medical and medication errors). We err on the side of keeping the organs functioning, whether or not that is what the person wanted, or what they considered to be living. We don't know how this person views what comes after death, and whether or not they are "ready" to die - not fearing death but understanding that it is the final act of a life well lived.

The doctor concludes, "Only after you make every effort to make me happy and human, ask me again if my life is worth living." This statement assumes that efforts of man can make us "happy and human". I can tell you from experience in many ICU's over 20+ years of dedicated and informed practice, that this is not possible - it will always be beyond human capacity to accomplish this - and placing this as the goal is what leads to professional burn-out. This statement also assumes that the medical model can in fact make us happy and human. Unfortunately, only a relationship with God - the God reflected in each and every person - can lead us on that path. Only our ability to live the truth that "God is God and we are not", will allow us to create the space where we can enter into that loving relationship with something much greater than ourselves - something that can heal us, something that can make us whole, something that can return us to our full capacity to love one another as we love ourselves. Only then will we be what God intends, only then will we encounter Shalom. All else is idol worship at its most tragic.

So, I encourage you all to get Advanced Directives and make sure that they follow you where ever you go. Make sure you have a health advocate and proxy for decision making that will strongly advocate for your wishes. Spend time with folks who understand end-of-life care (like us at PJ) and the vagaries of intensive care, so that you can make informed decisions about who you are and what makes life worth living. Do it today, before you end up in an ED some where with plastic tubes in your body and others making decisions on what is "best" for you.

Peace,
Dan