THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, November 24, 1995 TAG: 9511210129
SECTION: VIRGINIA BEACH BEACON PAGE: 16 EDITION: FINAL
TYPE: Prime Time
SOURCE: Pam Starr
LENGTH: Medium: 99 lines
Say you're a 90-year-old woman who has just had a heart attack. You have no pulse and you aren't breathing.
Your son called 911 and emergency medical technicians have arrived to administer lifesaving measures.
But they pause at your bedroom door to read a ``Do Not Resuscitate'' order. They see that you have no pulse and offer you comfort care instead of advanced lifesaving procedures. Without the order, you may end up living in a coma for another year before dying.
Do not resuscitate orders have been around for several years, but they've become more commonplace in the past couple of years. Bill Kiley, Emergency Medical Services administrator for the city, said that a do not resuscitate order is a sensible way of dealing with the reality of death for the terminally ill.
``It's pretty straightforward stuff,'' Kiley said from his office on Arctic Avenue. ``DNR is nothing more than an order telling us not to save their lives. In the past, we would have had to give care.
``But only if the patient is not breathing or does not have a pulse do we stop working,'' he emphasized. ``We will give comfort care - intravenous fluids, oxygen and pain medication.''
A do not resuscitate order is not a living will, Kiley emphasized. A living will deals with the quality of life. Three factors must be present for the courts and doctors to honor a living will: you must be in a terminal condition; there is no chance of recovery; and death must be imminent. Only then can life-prolonging procedures be withdrawn.
A do not resuscitate order is simply a prescription for emergency personnel to follow. If there is a pulse, personnel have to administer first aid and cardiopulmonary resuscitation. And if a patient is sick or ill - say with pneumonia - he or she will receive the same treatment as anyone else.
``So many people feel that once they sign an order, they're marked for death,'' Kiley said. ``We don't wait for them to die. DNR only kicks in when there is no pulse or breathing.
``We'll take them to the hospital, where the living will comes into place,'' he added. ``If they die while we're there, we provide support care to the family.''
People who want a do not resuscitate order can obtain one at the Health Department or from their family doctor. The patient or person who has power of attorney signs the form along with the attending physician. Emergency medical personnel look for the orders on the back of the door leading to the patient's bedroom, on the bedside table, on the refrigerator or in the patient's wallet. It's also available as a bracelet.
Dr. Jeff Charlton of First Colonial Family Practice has signed hundreds of these orders over the years and said that it's getting more popular.
``Ninety percent of a patient's medical costs are usually spent in the last year of his life,'' said Charlton. ``Thousands and thousands of dollars are spent to keep him alive. The last thing we want to see you do is end up as a living vegetable on a machine.''
Kiley said he believes that do not resuscitate orders reduce the stress on the spouse and the family but add to a paramedic's tension. Paramedics are trained to save lives.
``Paramedics cannot override a DNR order to be ``Johnny Hero,'' said Kiley, ``or they could be charged with assault.''
Here's what the patient signs on the Virginia Emergency Medical Services do not resuscitate order:
I, the undersigned, hereby direct that in the event of my cardiac or respiratory arrest, efforts at cardiopulmonary resuscitation not be initiated. I understand that I may revoke these directions at any time by physical cancellations or destruction of this form and the accompanying bracelet, or by orally expressing a desire to be resuscitated to Emergency Medical Services (EMS) personnel. I also understand that if EMS personnel have any doubts about the applicability or validity of this order, they will begin cardiopulmonary resuscitation.
The following part of the do not resuscitate order is signed by a designated agent or other authorized decision maker:
I, the undersigned, hereby certify that I am authorized to provide consent on the patient's behalf by virtue of my relationship to the patient as ------ (in order of priority: designated agent, guardian or committee, spouse, adult child, parent, adult brother or sister, other relative in descending order of blood relationship). In that capacity, I hereby direct that in the event of the patient's cardiac or respiratory arrest, efforts at cardiopulmonary resuscitation not be initiated. I understand that I may revoke these directions at any time by physical cancellation or destruction of this form and the accompanying bracelet. I also understand that if EMS personnel have any doubts about the applicability or validity of this order, they will begin cardiopulmonary resuscitation of the patient. MEMO: Bill Kiley is available to talk to groups about do not resuscitate
orders. Call 437-4850.
ILLUSTRATION: Staff photo by CHARLIE MEADS
Bill Kiley, Emergency Medical Services administrator for the city,
says a ``do not resuscitate'' order is a sensible way of dealing
with the reality of death for the terminally ill.
by CNB