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Monday, April 9, 2018

Texas’ New “Do Not Resuscitate” Law Now In Effect | Houston Public Media

There are common myths and misperceptions about a do not resuscitate (DNR) status. 1. DNR means do nothing: Myth. Indeed, a person with a DNR status receives the same level of care as someone without a DNR status with the exception that resuscitation is not attempted if there is cardiopulmonary arrest. Thus, a person with a DNR status gets medications, procedures and surgeries the same as anyone else. Indeed, one can be under a DNR status for a lifetime and encounter no limitation in medical care. 2. CPR is often successful: Myth. 90% of resuscitative efforts portrayed on TV are successful while the reality is the inverse--90% of resuscitative efforts in real life are unsuccessful. 3. I have to decide to "pull the plug" on grandma: Myth. DNR, like any medical recommendation, is a medical recommendation. The role of the patient or guardian is to accept or reject the medical recommendation. In the eyes of Texas state law it is the physician's obligation to make such a recommendation because only a physician has the medical knowledge to interpretation the medical information and clinical context and is then able to ascribe a prognosis. To ask the patient or guardian to do so, is considered to place such persons in the position of the unlawful practice of medicine and breach state law. In such a discussion, your physician should always make a statement of, "my recommendation is...." It is considered unethical for a physician to regurgitate a bunch of medical data to patient or family and say, "tell me what you want to do," and walk out of the room. If you do not hear a statement of recommendation, seek clarity. 4. A guardian or power of attorney (POA) can over rule the patient's DNR preference: Myth. Your legal obligation as a POA/guardian is to make the decision as the patient themselves would have made it had they retained capacity (even if you would have chosen differently for yourself). Think of it this way, if you were the POA for a person's dietary preference and you know they love broccoli, but you yourself detest broccoli, you would have to order broccoli. If you are not able to sincerely live up to those obligations of being a guardian/POA, you should decline the obligation when a loved one so requests and allow someone else to fill that role. 5. Absence of a written directive offers no guidance: Myth. Guidance to guardians/POA may be explicit (written) or implicit. Without an explicit statement there is often an overwhelming amount of implicit evidence regarding a patient's preferences such as statements the patient may have made regarding end of life cases portrayed in the media, discussions around the family dining table regarding such matters, and level of engagement in one's medical care. For instance, a person who spent their entire lives askewing medical contact, rarely goes to the doctor's office, does not take prescribed medications as directed, or values independence and self-reliance is not likely to suddenly change their embrace of medicine at the end of life and desire aggressive and heroic efforts. Lastly, be aware of a type of DNR called do not resuscitate-allow natural death (DNR-AND). DNR-AND is often used when under hospice care or when death is imminent. Under a DNR-AND status, only comfort care to alleviate suffering is offered (other medical care, procedures or surgeries--if not to afford comfort--are not offered). The goal is to allow death to occur with dignity and as naturally as possible without artificial interventions as mankind has done for ages. https://ift.tt/1VMjaZw
from Rajesh Harrykissoon, MD