DNR Orders, Thoughts on Feeding Tubes, etc. (cold, doctor, danger)
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I think I read somewhere on CD of someone who had a DNR order, but then was put on a feeding tube and subsequently died shortly thereafter.
It made me think about DNR orders and how they are not followed by first responders and most medical providers.
I managed the care of both of my parents through lots of illnesses, so I saw a lot of stuff.
They both had Advance Directives, which spelled out DNR orders. The hospitals did not even read these orders and I had to insist they put them in the chart.
I was called to a nursing home one time, because a parent had gone into distress and they dialed 911 (even though there was not only a DNR order but a sign I had made put up so everyone could easily see). When I got there, firefighters were in the room reviving my parent.
I figured out that when you dial 911, the first responders WILL RESUSITATE. That is what they do. The danger of resuscitation to a frail, old person, is they can have their ribs and other stuff crushed, and they can end up in a vegetative state or just really in a lot of pain.
On the feeding tube issue, I was thinking of an elderly person who had a stroke, and she was sent home with a feeding tube. Her family cared for her for a year before she died. She would have died immediately, but they (or she, not sure) wanted the feeding tube. She couldn't move this entire time and was unable to talk - it was really, really difficult to take care of her (moving her to change her, etc.). They were on-call 24/7. They didn't seem to have an issue with it, but I personally think it is crazy that people want feeding tubes, and it made me wonder what the genesis of feeding tubes is - who decided that feeding tubes were the way to go and when did the public jump on that bandwagon, and why?
On the feeding tube issue, I was thinking of an elderly person who had a stroke, and she was sent home with a feeding tube. Her family cared for her for a year before she died. She would have died immediately, but they (or she, not sure) wanted the feeding tube. She couldn't move this entire time and was unable to talk - it was really, really difficult to take care of her (moving her to change her, etc.). They were on-call 24/7. They didn't seem to have an issue with it, but I personally think it is crazy that people want feeding tubes, and it made me wonder what the genesis of feeding tubes is - who decided that feeding tubes were the way to go and when did the public jump on that bandwagon, and why?
Your personal views do not give you carte blanche to criticize or dismiss anyone else. There are situations where a feeding tube makes sense, particularly if the PATIENT decides they want to be supported in this way. What "public bandwagon" are you talking about? It's just an available option, nothing new. Back in 1978 during the last 9 months of her life my mother used a feeding tube. She was lucid, aware, could communicate even though she had lost voluntary control over her larynx, throat, couldn't swallow or control her diaphragm. Her doctor explained her options and let her make the decision. She wanted to spend as much time with family as possible and the tube would be necessary to carry out her wish. It never occurred to anyone in the family to judge her or override her decision if we didn't agree with it.
If you don't want artificial nutritional support or a feeding tube make that plain in your OWN advanced directive/DPOAHC/POLST. Leave other people's choice to them. BTW, a DNR order is specific to CPR, not nutritional support. If someone has a DNR on file with a medical facility but EMTs respond to a situation OUTSIDE that facility they will not honor it. They do not make that decision. They resuscitate.
Last edited by Parnassia; 10-21-2018 at 03:36 PM..
I think I read somewhere on CD of someone who had a DNR order, but then was put on a feeding tube and subsequently died shortly thereafter.
It made me think about DNR orders and how they are not followed by first responders and most medical providers.
I managed the care of both of my parents through lots of illnesses, so I saw a lot of stuff.
They both had Advance Directives, which spelled out DNR orders. The hospitals did not even read these orders and I had to insist they put them in the chart.
I was called to a nursing home one time, because a parent had gone into distress and they dialed 911 (even though there was not only a DNR order but a sign I had made put up so everyone could easily see). When I got there, firefighters were in the room reviving my parent.
I figured out that when you dial 911, the first responders WILL RESUSITATE. That is what they do. The danger of resuscitation to a frail, old person, is they can have their ribs and other stuff crushed, and they can end up in a vegetative state or just really in a lot of pain.
On the feeding tube issue, I was thinking of an elderly person who had a stroke, and she was sent home with a feeding tube. Her family cared for her for a year before she died. She would have died immediately, but they (or she, not sure) wanted the feeding tube. She couldn't move this entire time and was unable to talk - it was really, really difficult to take care of her (moving her to change her, etc.). They were on-call 24/7. They didn't seem to have an issue with it, but I personally think it is crazy that people want feeding tubes, and it made me wonder what the genesis of feeding tubes is - who decided that feeding tubes were the way to go and when did the public jump on that bandwagon, and why?
Feeding tubes have been around for over a hundred years. They're not remotely new.
A DNR is a good thing, but it does not cover feeding tubes nor other end-of-life issues. For that, you need an Advance Directive, on file with your primary physician and included in your hospital admission paperwork. Not to mention that your spouses, siblings, parents, adult children all need copies as well.
Anyway, the reason I posted was to note that hospitals don't necessarily honor DNRs that are spelled out in Advance Directives - AND - I am curious about people who prefer to have feeding tubes - I was interested in the history, and how this became a default. I personally do not want one.
Anyway, the reason I posted was to note that hospitals don't necessarily honor DNRs that are spelled out in Advance Directives - AND - I am curious about people who prefer to have feeding tubes - I was interested in the history, and how this became a default. I personally do not want one.
TBH, your post was all over the place, mixing the two issues together. Hospitals do honor advanced directives and DNRs. Anecdotal, but I can bring to mind relatives and one friend who had theirs honored when hospitalized. What happened in your relative's case we can have no idea. You've posted about that in other threads. Maybe you need to find a way to get past it. It's history and nothing will change it. Why does someone's choice for a tube matter to you? Your post gave the impression you think it's wrong. Nobody facing this decision cares what you think and I would hope you would never impose your opinion on them. Who says this "became a default"??? Older versions of so-called "living wills" (replaced by current forms of advanced directives) didn't always spell out the specifics of artificial feeding and hydration, but they do now. That is what POLSTs also state.
Of course it is!! It is also extremely specific to each patient's situation. I doubt these dilemmas are going to be put to rest any time soon especially if some patients never get around to stating their wishes. Unfortunately, there are many people who can't bring themselves to face thinking about it or putting a directive in place. And, I also suspect in some cases even if they did, a meddling relative could refuse to accept their choice, to impose their own feelings on the situation leaving everyone in more misery.
My dad has a feeding tube. He's got end stage Alzheimer's and MS, and can't really communicate, walk, use his hands, etc. He had aspiration pneumonia twice and they determined that he couldn't swallow anymore. My mom insisted on having the tube placed. I felt like she was really prolonging his suffering, but when I visited, he was chewing his hands and crying, which is how he indicates hunger, and I understood that she couldn't bear to watch him do that for however long it took him to die from not eating.
and just so you're aware, it's not just the frail elderly that suffer injuries and poor outcomes during a code.
I am not surprised. It is the frail elderly that have DNR's in place that I was specifically referring to because the relatives think when there is an Advance Directive, that wishes will be honored, and for liability reasons (guessing), when you dial 911, resuscitation happens. In the case of my relative, the nursing home dialed 911, even WITH the DNR.
When another relative was dying, I had to convince someone in the house not to dial 911. I said, "do you want him dying on a cold gurney, or here at home (which was his wish)?
I made the post because I don't think it is common knowledge that first responders resuscitate no matter what and that hospitals do not always honor Advance Directives. For people who did not know this, they can now advocate for their relatives.
On the feeding tube issue: It is a moral and ethical dilemma if there is no Advance Directive. I was happy to have had parents who spelled things out and it gave me a chance to consider for myself what I would want - and it would not be that. My reason is that I would never want to burden anyone else and I also believe when it's "your time" to go, you "should" go . . . it's a personal viewpoint - not telling anyone else what to do, which I was bizarrely accused of - lol.
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