As a nurse and attorney, I can tell you I was so uncomfortable reading about the nurse who refused to give CPR to the dying resident in the seniors’ community where she worked. I got a sick feeling in my stomach. But there is a lot to this story.
I believe there should be exceptions in non health care residences for emergencies like the one involving this senior, Lorraine Bayless. A nurse who is on scene should be able to do what any trained lay person can do: administer CPR when someone stops breathing.
The press reports that there was no Do Not Resuscitate (DNR) direction in place. Ms. Bayliss’s family believed that she wanted “to die naturally and without any kind of life prolonging intervention” as they told the Associated Press. Glemwood Garden’s policy about what the nurse should do in an emergency was sufficiently unclear that owner Brookdale’s public statement was to the effect that the nurse had “misinterpreted the company’s guidelines.” What those guidelines were is not certain.
We have legal documents that allow anyone to make quite clear what they want in an emergency such as stopping breathing. There is a DNR statement or order. There is an advance health care directive to guide others if the person in no longer conscious or competent. There is a newer document called Physician’s Orders for Life Sustaining Treatment (POLST) in some states, also called Medical Orders for Life Sustaining Treatment (MOLST). A doctor signs it and it’s posted appropriately. It allows others to be comfortable following the person’s wishes, even if the wishes say don’t keep me alive.
This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did. If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.
Either you want emergency intervention or you don’t. If you are very clear that you do not want to be resuscitated when you stop breathing, let the people where you live know what you want and put it in writing. Post it in a prominent place and give it to the administrator of any seniors residence you choose as your home. If you have clear statement that you don’t want resuscitation and you stop breathing, no one should call 911. Paramedics will attempt CPR every time. CPR is definitely life prolonging intervention. The legal documents mentioned above allow you to spell out under what circumstances you want to be kept alive. It is not always so straightforward as stopping breathing, or a sudden event.
We’re in a society that is generally phobic about death, much more than many other cultures in the world. Death in many other places is accepted as the natural end of life and people don’t spend as much time avoiding the very idea. In our culture, we seem to think it’s optional. We don’t like the idea of planning for the end.
Perhaps Lorraine Bayless has left us all with an important wake up call. Independent and assisted living senior residences need clear written policies about resuscitation of residents. If nurses happen to be working there, they should not be frozen in place when a resident collapses and CPR can be administered by someone, including themselves. Residents should be required to spell out their end of life wishes and emergency instructions and these should be available to those in charge. And each of us needs to face the reality that no one gets out of here alive. We need to think it out, write it out, and do our loved ones and those who help us the decency of making our wishes clear to them. If a person wants no resuscitation, we have to accept the idea that we don’t have to “do something” if they stop breathing.
As we’re in the elder and family consulting business, I made sure my husband Mikol and our kids know about my own wishes. I’m pretty sure that when it’s my time to kick the bucket, they’ll let me kick it and get out of the way. It’s not so bad to exit the way Lorraine did, fast, and probably without pain. Her family says she had it her way.
What would your way look like?
Until next time,