License to Die

 

“License and Registration, Please”

First, thanks to everyone who read (and commented) yesterday about the “no-CPR” incident.   This update from the press:  ”Lorraine Bayless had chosen to live in a facility without medical staff and wanted to pass away without life-prolonging intervention, her family said Tuesday.”

Most, but not all,  commenters were somehow related to the health field.  But,  several folks shared their own experiences with a loved one which was quite valuable.

Common words were legality, professional, Do Not Resuscitate(DNR), duty, and licensing.  Even writers that were quite concerned about the ramifications of not acting expressed the need for people to die with dignity and freedom.

It’s hard not to conclude that in our litigious and buttoned-down society that the DNR order has become a license to die.  Without it, you risk ignominy or worse.  According to the Pasadena News, “City fire officials say Bayless did not have a “do not resuscitate” order on file at the home.”  Conservatives worth their salt and any libertarian should be aghast to know that you now need the city’s permission to die.

A Pioneer Death

She’s in the Parlor

Many of us are fortunate to have people in our lives who can recall a death at home where the corpse never left the house until the burial.  They were washed and dressed and placed in the parlor for folks to come and pay their respects.

Such a thing is probably illegal now but it illustrates how the process of death these days routinely includes transfer to a hospital, which should seem a little odd.

In one sense, this “we die at the hospital” mentality has now been walked back to the point that you are not allowed to die outside the hospital unless you have your DNR passport.

The emergency response system, including EMS, fire and 911 call takers are now part of the “you must die at the hospital” culture we live in.  In fact, Bakersfield became a story over a call taker’s “heroic” efforts to recruit a CPR provider.

The Last Trip

As a society we have created an environment where the universal last, great trip is being robbed of its ambiguity, grace and freedom.  In fact, the current system, especially for those content to go, argues in favor of a solitary death where the risk of interference is minimized.  We are all ultimately alone at the end, but that is a high price to pay.

I have several people in my life who “are ready.”  And, I have known others.  I hope that when their time comes that they make their transition free of pain, but with grace and dignity.

Thanks, again.

 

12 Comments

  • Tim Walker says:

    I was born ready.

  • Alan says:

    Please rename blog post title to “Told You So” or “I was right I was right”. Kthxbai.

  • Smitty says:

    Yesterday’s blog post and discussion and again today’s blog post and discussion i really interesting. This is a very important topic as we baby boomers age to our deaths (or our parents age to theirs). On television and in the movies, it’s all so neat and clean. Even in the bloodiest of movies, one dies instantly or is engaged in interaction with one’s murderer to distract from the pain and angst of dying. It’s not like that in real life. We make hard decisions; we sit with our loved ones and watch them slowly or painfully wend their way our of life and out of our lives. In real life, there are rarely 30-second deaths as happens on the screen.

    So much to ponder. I think it’s unfair to leave these decisions to total strangers or our loved ones. A medical power of attorney and a DNR (if we so choose) are musts.

    Thanks, Eric, for spurring this conversation.

  • Ben says:

    It doesn’t need to be complicated. If you don’t want CPR performed on a loved one, don’t call 911.

  • Bill Carey says:

    “It was our beloved mother and grandmother’s wish to die naturally and without any kind of life prolonging intervention,” the family said. “We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace.”

    From our coverage over at JEMS, http://www.jems.com/article/news/family-woman-cpr-refusal-satisfied-facil

    Of course, now the finger-pointing looks at the nurse and “policy”.

    Bill Carey

  • Dennis says:

    Eric,

    Thanks for the followup to a very good blog post. Back in the day, when DNR stood for Department of Natural Resources, and HLRs occupied an outside compartment of an ambulance, people like you and I would work on every cardiac arrest as long as they did not have Rigor or Lividity. I don’t think that was a bad thing, it showed a respect for the importance of each life. However many years ago, (thank God), medical ethics caught up with advanced pre-hospital medical care and we now have a plethora of medical directives which honor a person’s wishes for life, death, and quality of life decisions. I was fortunate enough to be with my sister Lynne at the hospice when she died of Breast Cancer at the age of 49 in 2006. It should not matter if it is a hospice or someones family room, if someone wishes to have no heroic measures performed, that should be respected. DK

  • Victoria Huckenpahler says:

    For Ben: Ben, I understand what you’re saying, but it can often be disconcerting and frightening to be in the presence of someone “actively dying,” as the terminology goes. They can have great trouble breathing, and other discomfort. The natural, knee-jerk reaction is to grab the phone and dial 911. Specifically, even if there is a DNR, that does not mean that the person shouldn’t receive oxygen and possibly morphine for comfort. To avert calling 911 you need something in place, such as Hospice, that will provide the above-mentioned comforts without contradicting the person’s essential wishes.

    For all: There is a superb book out called Dying With Confidence. It is written by a Tibetan Lama, and though it speaks to that audience, it has many items of a very practical nature available to all, particularly in the appendices. I will herewith give you all some website resources you may wish to check out: Amer. Hospital Assn.’s http://www.putitinwriting.org; Aging with Dignity’s http://www.agingwithdignity.org; Nat’l Hospice and Palliative Care Org.’s http://www.caringinfo.org; Crossings’ http://www.crossings.net; Natural Transition’s http://www.naturaltransitions.org; Final Passages’ http://www.finalpassages.org (includes a link to a book available on the laws of all states; and http://www.undertakenwithlove.org.

    For Eric: Thanks for providing a forum for civilized discourse.

    Victoria (Dolma) Huckenpahler

  • John says:

    I’m in favor of doing all we can for someone who has not deliberately chosen a DNR, but also for more people choosing a DNR. The problem is that people are not informed or educated of their options. We have DNRs and hospice for those who do not wish to be resuscitated. By not having a DNR, which anyone can get for free on their own without a lawyer, it can be assumed that you DO want someone to attempt resuscitation. People just don’t know.

    My father died of lung cancer at age 60. He was in stage 4 for months and suffering from excruciating pain while still going through chemo/radiation that his doctors admitted would not improve his quality of life or extend it. No doctor ever mentioned hospice until I brought it up. Once he signed the DNR all of his doctors walked out and wouldn’t even call him back. He died 3 weeks later.

    Doctors seem afraid to even mention DNRs or hospice to people who are obvious candidates for them. It is amazing how many 88 year old stage 4 cancer patients in nursing homes don’t have DNRs. I regularly discuss DNRs/hospice with patients and families on calls. It is not an easy conversation, but that’s why we get the big $$$ (sarc).

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Eric Lamar

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