CONSIDERING D.N.R.– Do New “Facts” Change Anything?

The NYTimes features on ‘The New Old Age” are worthy of perusing.  In a recent piece by Judith Graham http://newoldage.blogs.nytimes.com/2013/03/14/healthy-rate-of-survival-for-elderly-saved-by-cpr/?src=recg&pagewanted there is a discussion regading new data on the outcomes of “code blue” resuscitation on patients 65 and older.  Such data seem to indicate that of the 18-20% who survive these efforts 58.5% are alive after one year.  Of this number 52% had moderate or severe neurologic damage.  The article seems to suggest that those who survive have reason for “hope”. But the author does acknowledge that there was no attempt to evaluate the quality of that life that was “saved”. 

There is no question that these end of life issues continue to be provocative and extremely controversial.  The article might lead one to be less likely to sign a D.N.R. form than previously. 

I believe the most reasonable approach (and one offered in this piece) is to realistically evaluate the quality of life we all experience on a periodic basis.  Why not make this an annual serious soul-searching event?

When cognitive decline reduces a once viable human being to a nonfunctioning one then why prolong this level of existence by means of cardiac resuscitation?  Would you want this state of existence for yourself?  But doesn’t this extend to physical suffering?  If a progressive neurological disorder renders someone all but helpless, should they not have some say in the prolongation of there life as well?  Should our goal be the number of years we or our loved-ones exist or their quality?

Again, we are dealing with the most difficult of life’s questions.  We need to continue to discuss them openly and frankly.  Will there ever be a template or algorithm that can or should be applied to everyone? Clearly not. But waiting to the moment of crisis or allowing family members to contravene our own wishes regading D.N.R. needs to be seriously addressed as well.

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