Plan Ahead for a Dignified Death

Last week, my friend Evelyn sent me a red rose in memory of my mother. Evelyn also had a question, “Why an elderly lady in a nursing home was denied treatment because her nursing care status was DNR 3?” Let me give you some personal examples to answer the question.

Yesterday (December 1) was my mother’s 88th birthday. But she wasn’t here to celebrate. So the red rose was timely. The red rose and the letters DNR brought back memories of my parent’s last few hours or few days in this world.

In my dad’s case, he had a severe heart attack at home. The paramedics revived him, put him on a breathing machine and transported him to Foothills hospital.

As I was about to leave for Calgary, my dad’s cardiologist phoned me to say that my dad’s chances of recovery were minimal and needed directions regarding resuscitation and how long to prolong his life on a breathing machine. He wanted me to discus the situation with the rest of the family since my dad had not left any written direction regarding such matters. We chose DNR 3.

In my mom’s case the situation was little different. She was diagnosed with terminal cancer. She was given a choice between receiving chemotherapy, with its unpleasantness and no chance of cure vs. tender loving care with no active treatment to avoid unnecessary prolongation of sufferings. My mom was mentally alert and was able to make an informed decision after a family discussion to let nature take its course. That means she elected to be DNR 3.

DNR stands for “do not resuscitate”. DNR provides guidelines for resuscitation levels depending on patient’s condition. Resuscitation care decisions are made by the attending physician in consultation with the patient, if the patient is mentally capable of making that decision. Otherwise the physician has to discuss the situation with the patient’s family members or a legal guardian. If there is no next of kin or a legal guardian then a second physician is consulted.

DNR has three levels: DNR 1, DNR 2 and DNR 3.

Patients on DNR 1 receive total supportive treatment including CPR (cardio-pulmonary resuscitation). The patients receive all aggressive medical, nursing and paramedical intervention including mechanical breathing machine and defibrillation. This status is given to all new patients in acute care unless they have a personal directive which gives clear instructions otherwise.

Patients on DNR 2 have to be deemed to have a poor likelihood of returning to a stable condition after CPR. Patients under this status do not get CPR or mechanical breathing. They receive all other supportive treatment.

Patients on DNR 3 receive comfort measures only as they are deemed to have an illness or condition which does not have a cure or provide a good quality of life. Therefore these patients receive only tender loving care.

The whole purpose of DNR policy is to allow people to die with dignity. That is why it is important to have a personal directive. A personal directive is a legal document you write in case you cannot make your own personal decisions in the future. The document lets you choose another person, an agent, to act on your behalf and make decisions for you when you cannot make them yourself.

You can have a personal directive if you are 18 years or over. Personal Directives Act (December 1, 1997) requires that for a personal directive to be valid, it should be signed, dated and witnessed. For more information you should visit Alberta Seniors and Community Supports (Office of the Public Guardian) website at www.seniors.gov.ab.ca. Their phone numbers: Edmonton office 780-422-1868, Lethbridge office 403-381-5648.

If you do not have a personal directive then you should get one today.

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