Author Gathering Place

Roland Halpern

‘Do not resuscitate’ order
gives little real assurance

Think you have the right to refuse cardio-pulmonary resuscitation? Think again.

"You mean this won't do me any good?" asks an elderly woman who jiggles her wrist in front of me to expose a Do Not Resuscitate (DNR) bracelet she purchased through the mail.

"I'm afraid it won't." I reply. Disappointed, she walks away with a look on her face that I have seen far too often.

Increasingly, the No. 1 question that comes up at my presentations on end-of-life concerns is the issue of CPR and DNR orders. Most people assume that if they don't want these procedures, their wishes will be honored. Unfortunately, they are wrong.

Despite several Supreme Court decisions upholding a person's legal right to refuse unwanted medical treatment, when it comes to resuscitation, at least outside of a hospital setting, you are likely to be thumped, pumped and subjected to electrical shock, even if you are fully conscious and saying "No!"

In reality the success rate of CPR pales to that portrayed in television dramas. The chances of successful revival are less than 5 percent and the consequences of surviving often grim. One study found that 62 percent of those who survived never regained consciousness and died after "living" in a coma or a persistent vegetative state. For those who regained some level of cognitive function, many were physically or mentally disabled, with 60 percent not surviving longer than six months.

In Hawaii the only way to avoid forced CPR is by wearing a prescription DNR bracelet or necklace, available only after your physician has declared you terminally ill, legally defined as suffering from an illness in which the probable life expectancy is six months or less.

If someone goes into cardiac arrest, does 911 have to be called? While most of us assume so, no one I spoke to at the four state and City & County agencies was able to refer me to a specific rule or regulation requiring it.

What is clear is that calling 911 sets into motion an unstoppable chain of events. "Are there any instances in which you would voluntarily forego CPR attempts?" I asked one paramedic. The reply was a short one, with "decapitation" being one of the less grisly exceptions.

A bill that would have allowed competent adults the right to obtain DNR bracelets was introduced during the 1993 legislative session. It was proceeding unopposed when several unrelated appropriations were attached at the last minute. The resulting re-referral of the bill to four different committees essentially doomed its passage. Whether it will re-emerge next session is unknown.

In the meantime, what are you to do if you clearly don't want CPR attempted? Two people I know of have "DNR" tattooed on their chests, although even this is unlikely to be honored.

For now, your best bet is to make sure everyone, including your physician, is aware of your desire not to be resuscitated. Make sure your Advance Health Care Directive is current and that you have clearly expressed your wishes for Comfort Care Only, which means the medical team will do what is necessary to relieve your pain and discomfort but will not attempt to revive you.

Inform your family that you do not want 911 called should you go into cardiac arrest. Similarly, if you are living in an assisted living or health care facility, make sure a DNR order is in your file and request that the staff refrain from calling 911.

If you are entering the hospital, even for a minor procedure, take a copy of your Advance Health Care Directive with you and let the staff know about your DNR request.

Roland Halpern is executive director of Compassion in Dying of Hawaii.


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