March 2018 – Article 1:   

(This is the sixth in a series of articles dealing with protecting the elderly and infirm).

Think doctors and hospitals always have patients’ best interest at heart? Think again.

Nationwide, “unilateral do not resuscitate” (DNR) orders are secretly slipped into patients’ files without family notification far more often than the medical profession likes to admit.

Georgia is no exception. Georgia Right to Life (GRTL) has received numerous complaints from families who learned their loved ones were victims of the devious practice.

The problem is even more troubling in light of the fact that most hospitals have policies requiring doctors to obtain patient or family approval to sign a DNR.

And while they would prefer to keep the situation hush hush, an alarming number of health professionals support the idea.

Study of 1,1 50 Physicians

A study of more than 1,150 physicians conducted by the medical department at Northwestern University found that roughly half support the use of “unilateral” DNRs, which means physicians issuing such an order without anyone’s knowledge or consent.

Six percent of those surveyed, including 20 percent of pulmonary critical care doctors, admitted they had secretly signed a DNR order in the previous year.

One telling fact revealed in the survey was that those favoring unilateral DNRs were less likely to be religious.

DNR Prohibits Performance of Cardiopulmonary Resuscitation

A DNR order instructs health care providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or their heart stops beating.

A CPR procedure can involve:

• Simple efforts such as mouth-to-mouth and pressing on the chest (which can be painful, even resulting in cracked ribs).
• Electric shock to start the heart.
• Breathing tubes to open an airway.

If the attending physician decides CPR would be of no value because the patient’s death is thought to be eminent, they usually recommend issuing a DNR order. But such an order should only be imposed after consultation and agreement with the individual, and/or their surrogate healthcare representative.

More troubling is the fact that doctors increasingly recommend such orders based on their personal value judgement that keeping the patient alive will result in a “poor quality of life.”

Conflicts arise when the patient or their surrogate wants all treatments—including CPR if needed—to continue living and the physician disagrees. That’s when a secret DNR order can find its way into the patient’s file.

Also troubling is that when a DNR order is placed in a patient’s file it can lead to other treatments being withheld, despite the fact that it’s only supposed to apply to cardiac arrest or pulmonary failure.

Forced DNRs Reflect Culture of Death Values

Such attitudes are typical of our nation’s growing culture of death that increasingly views the elderly and infirm as having no value and as simply being a burden on society.

“In the not-to-distant past, families were concerned that physicians were keeping their loved ones on life support too long,” explained Chen Onarecker, chair of the Healthcare Ethics Council at Trinity International University Center for Bioethics & Human Dignity in Deerfield, IL.

Now it’s more common for families to worry that medical teams are withdrawing life support too soon.

“Secretly ignoring patient wishes is an onerous breach of the trust that should exist between  people and their doctors,” GRTL President Ricardo Davis said. “We will give serious consideration to legislative solutions that restore that trust.”

Texas recently joined several other states in passing laws that protect patients from being the victims of forced DNRs. The law requires doctors and hospitals to obtain consent from patients or their surrogate before issuing such an order.

Up to Date Advance Directives Needed

In the meantime, GRTL urges everyone to have an up-to-date advance directive. An excellent one can be obtained here.

The directive must make clear that:

• You have a properly assigned healthcare surrogate(s) who completely understands your wishes.
• If you are not able, your healthcare surrogate must agree that a DNR order not be placed in your file without their consent.
• You do not want anything done to unnecessarily prolong the natural dying process, nor anything done that would hasten or directly cause your death.
• You are not to be assigned an attending physician who has a “right to die” bias.

Most importantly, make sure your physician(s) and hospital have a copy of your advance directive and demand that they honor it.

Also, if this issue is ever brought before the Georgia Legislature, please be prepared to offer your help in expressing your pro-life support to your elected officials.

It is paramount that the personhood of all individuals, no matter their age or level of ability, be protected and preserved and that the sanctity of human life be upheld in every case.

Sources: ahcmedia.com; staradvertiser.com; texasrighttolife.com; medlineplus.gov; nationalreview.com; ncbi.nlm.nih.gov.

By Wayne DuBois

Georgia Right to Life

Media Relations Advisor