CPR can crack ribs and only succeeds longterm in restarting a heart 20% of the time --

[pnwmom]

that is, the heart functions long enough for the person to be discharged from the hospital.

And in the elderly, the risk of fractured ribs and sternum is even higher than for younger people -- and the chance of extending life is much smaller.

If you were 87, would you want to spend your last moments in life getting your bones broken in the small chance that your heart would start up again?

If not, get a DNR, because if someone calls 911, in the absence of a DNR they are obligated to try.

http://newoldage.blogs.nytimes.com/2012/08/10/more-on-cpr-for-the-elderly/

I’ll confess I was startled to learn, after too many episodes of “ER,” how rarely cardiopulmonary resuscitation succeeds in restarting someone’s heart. The rate of long-term success is probably about 20 percent, said Dr. David John, former geriatrics chairman of the American College of Emergency Physicians. “When your heart stops, it’s really hard to get it back,” he said.

“Long-term success” has a particular definition here: It means that a patient, after cardiac arrest, survives long enough to be discharged from a hospital. Studies often don’t report what happens thereafter. But even that modest kind of success occurs less frequently in older people who receive CPR, declining slightly for those in their 70s, then more steeply for those in their 80s and 90s, several studies show. And like any other medical intervention, CPR involves its own risks.

This can all seem very abstract to a healthy middle-aged person with no history of heart problems. But as people age, and increasingly cope with multiple diseases and frailty, the issue grows more urgent and more complex. The blunt question: Should a frail, elderly person receive CPR?

SNIP

___________________________

(Read on for two doctor's opinions)

[MADem]

1. How about the Shocker Pad Box?

Perhaps that will be The Next Big Thing for home use...? Like in airplanes and in gymnasiums...?

They'll sell 'em on late night Tee Vee....

'Don't crack Granny's rib trying to administer clumsy CPR--peel and stick, push a button, and before ya know it, Granny is back up dusting the furniture in no time!'

[pnwmom]

3. One of the doctors addressed that, too. He's only 66, though -- much younger than the CA lady.

“'If older people and their families knew all that was involved, the manipulation, the tubes, the drugs and the low chances for a good outcome, they’d opt for comfort care instead,” Dr. Davis said. He’s 66, and tattooed on his own chest is an informal advance directive: 'Shock Thrice,' meaning that after three attempts at defibrillation, the team should stop resuscitation and allow him to die.

&quot A recent editorial in The Journal of General Internal Medicine, by the way, argues that a do-not-resuscitate tattoo isn’t actually an effective way to communicate end-of-life wishes; an advance directive or POLST – physician orders for life-sustaining treatment – works better.)"


http://newoldage.blogs.nytimes.com/2012/08/10/more-on-cpr-for-the-elderly/

[FarCenter]

5. I don't think the defibrillators work if the heart is stopped.

They restore the rythm of an irregularly beating heart.

[pnwmom]

8. But a heart could be beating irregularly and very slowly --

so it might seem to be stopped when it wasn't.

[Aristus]

61. No. An electronic shock device can detect bradycardia (slow heart beat) and respond appropriately.

Shock is for atrial fibrillation (which is actually fairly common, and is something one can live with) and ventricular fibrillation, which is an emergency, and can be deadly. If a patient has asystole (no heartbeat), electrocardioversion very rarely works.

[Warpy]

102. A defibrillator doesn't start the heart, it stops it.

A heart in a disorganized rhythm like ventricular fibrillation is stopped by electricity and starts again on its own due to the nature of cardiac muscle. When it restarts, it often does so in a more normal rhythm.

Shocking a flatlined patient does absolutely nothing.

[MADem]

112. I have to say, I look askance at this "Let 'em die" guidance.

My suspicious mind is wondering if this isn't a roll-out by the medical lobby to just dump those higher-cost geezers by selling a touchy-feely "Grandma would like it BETTER if you just let her slip away" set of guidelines!

I have a family that likes to LIVE. I've got relatives in their nineties who are making plans five years out. I don't think any of 'em would appreciate being told that they might not get the full Monty in terms of CPR because they're "old!"

[pnwmom]

120. I don't have a single elderly relative who relished the idea of life so much

she wanted to end up tied to tubes and machines for months or years. But I do know a friend's grandmother who got stuck on feeding and breathing tubes for five years, despite being unresponsive and -- for the last year -- in a coma; and who was resuscitated four times till she finally died at 105. (Before then, the grandson in charge couldn't bring himself to sign a DNR.)

Each elderly relative of ours had a different plan, but they all wanted to be in control -- which this CA woman was, according to her daughter. She hoped for a natural death and she knew that the independent facility she was in wouldn't provide medical assistance.

[HiPointDem]

127. what your family wants is irrelevant. and the fact that *this* woman had a DNR is irrelevant to

the fact that this CORPORATION has a BLANKET NATIONWIDE POLICY OF REFUSING EMERGENCY AID to residents in its independent living facilities.

[MADem]

134. Well, I guess the point I'm trying to make is that it's fine and dandy

for the older person to make their own decisions, craft a DNR and let their family know what they want, but I don't like some 66 year old know-it-all with a "Shock Thrice" tattoo imparting "wisdom" to Boomer Children about what he thinks Ma and Pa might want.

It just smells bad to me...like the whole story is a forward scout, sniffing out how receptive the middle aged folks are towards "letting ma/pa go" -- it's almost like saying "Yeah, I see ma is out cold on the kitchen floor and turning blue, take your time dialing 911, or just wait a bit and call the coroner instead!"

Not sure if I'm expressing myself well, but time will tell--if this starts to be a theme on the talk shows, where the "sale" is that it's "OK" to pull the plug on Granny, "for her own good, of course," I'll start to smell a rat.

After all, the deader they are, the less they cost the health care industry! Makes room in the nursing home warehouse, too, so that they can milk a new patient dry at full cost before the "state aid" price tier kicks in.

Here is another view of the same issue:

Lorraine Bayless, 87, died later in the day on Feb. 26 after a Glenwood Gardens worker defied pleas of a 911 dispatcher to perform CPR. The worker cited a company policy that instructs Glenwood Gardens employees to call 911 and wait in if a resident is having a “health emergency.”
While a bias persists that the elderly might fare worse after a heart attack, studies find that an active 80-year-old who plays tennis, say, can better recover from cardiac arrest than a bedridden 50-year-old on dialysis.
Injuring the patient also shouldn’t be a worry, even with a very old person, said Dr. Benjamin Abraham, director of the Division of Cardiovascular Medicine at Ohio State University.
“With adequate or vigorous CPR, we may break a rib or two, but the benefit of doing that is to increase the likelihood of survival,” ...That’s true even for tiny infants, Abella said.

http://abcnews.go.com/blogs/health/2013/03/05/heart-experts-dont-think-just-do-cpr/

[pnwmom]

210. Perhaps it is true that

"an active 80-year-old who plays tennis, say, can better recover from cardiac arrest than a bedridden 50-year-old on dialysis." But a bedridden 50 year old on dialysis has poor odds if he has a heart attack.

In any case, this woman was 87 and had a history of artery disease and died of a massive stroke. CPR wouldn't have done her much good.

(Also, a Michigan study of more than 2000 patients found that only 3.3% of out-of-hospital patients over 80 had successful CPR.)

[HiPointDem]

128. Yet this 66 year old doctor WANTS emergency aid.

[marybourg]

2. Just a few weeks ago I administered chest compressions

to my 86 year old hubby. He came home from the hospital in 2 days and although he still has his degenerative disease, he's fine; I didn't break anything and I hope to keep him for some time to come.

[pnwmom]

4. I'm happy it worked out for you!

As the article implies, this should be a personal decision -- every person's medical situation is different. In the case of the California woman, her daughter afterwards said that she probably would have died anyway -- so I'm guessing her health wasn't as good as your husband's.

[aikoaiko]

6. If my heart stops, I'll take the 20% of survival and broken ribs

Thank you very much.

[pnwmom]

10. I would say that for me at my age now but I wouldn't at 87.

I've known plenty of people in their 80's. With most of them, they become more concerned about living a good life day-to-day and less concerned with extending it.

[cui bono]

43. Especially if it includes more pain and suffering. n/t

[MADem]

115. It depends entirely on health--I know people in their eighties and nineties who are still vigorous.

I have a friend who still shovels his walks in his mid-eighties. He's very sensible about it, takes his time, rests frequently, but it's "his thing" and he doesn't want any help. He's not interested in dying so long as he can get out there--his favorite song is "FAME," particularly the "I wanna live forever" line.

The closer you get to "old," the more your perspective changes, particularly when you know people who are even older who are still having a good time.

[elehhhhna]

50. I'm with you. WHEN I change my mind I'll say so

for now, bust a rib if you can a save my life! Hell, break my leg too, if it'll help...

[Brigid]

7. Could it be . . .

This is why that nursing home has a "no CPR" policy, and they are not quite the villains they have been made out to be?

[pnwmom]

13. I read that in CA an assisted living place has to have a special license to administer any kind

of medical care, and this retirement facility didn't have such a license.

I also read about another state (the city was Lincoln -- can't remember the state) that had a $10,000 fine if a retirement facility provided medical care without the required license.

[HiPointDem]

62. i doubt it; it was a facility with 3 levels of care & took public funding. ergo, it could give

medical care.

[pnwmom]

81. You're wrong. You can't take staff away from the licensed facility

and send them off to the independent living facility. Then your licensed facility would be under-staffed.

The license for the assisted living section doesn't extend to the independent living section -- which is why no charges will be filed and why the law needs to be changed.

[HiPointDem]

99. It's the *same* facility, providing 3 levels of care on the same campus. we have similar facilities

here, and in fact that facility belongs to a national corporation.

[liberal_at_heart]

15. I think it is wrong for the facility to take that stance

If they have residence that have a DNR then that is fine but for an entire facility to say they never do CPR and to make that part of the contract agreement to live there I feel that is wrong and I have to wonder if they are just trying to save money.

[pnwmom]

17. CA law requires a special license for a retirement facility to offer any kind of medical care.

WA state, to cite another example, does not require a special license for CPR. So maybe CA needs to change its law.

[liberal_at_heart]

23. why can't they get the required licence?

A facility that takes care of old people will inevitably have medical issues arise. It needs to be part of the business model. Get the licence. Train your staff. Get your staff certified. If they don't want to deal with medical issues then they shouldn't be in that business.

[pnwmom]

26. Then it would be an assisted living facility, not a retirement home.

To get the CA license, they'd have to basically turn the retirement unit into an assisted living facility, with the required medical personnel. Assisted living residences cost more money and many retirees don't want to live in them till they think they have to.

There is a different business model for retirement homes, which are apartments or small homes with meal and bus service; and assisted living facilities, which offer meals, bus service, AND levels of personal care and attention to medical needs.

I think CA should change its law. WA state, where I live, doesn't require an assisted-living license for a retirement home to administer CPR. Neither should California.

[liberal_at_heart]

27. If you have residence in their 80's they are going to need medical assistance.

[pnwmom]

32. Lots of people live independently in their own homes in their 80's without medical assistance.

Meals on Wheels is a wonderful help to keeping them in their homes, by the way -- good food is as important as anything else to their health.

Sometimes the main reason they move into a retirement home is because they stop driving, and they feel isolated. My mother-in-law moved into an assisted living place in her eighties after having surgery; and as soon as she could, she moved out and into the retirement part of the facility. She didn't see any need for the "extras" after she recovered from the surgery.

But in my state a retirement home doesn't need a license to do CPR, so the situation would have been different for that CA 87 year old if she'd been here.

[liberal_at_heart]

36. I still think retirement homes should have CPR certified staff and should offer CPR to those who

don't have a DNR.

[pnwmom]

39. As I said, that's the case for WA retirement homes.

But in CA, it seems to be an all-or-nothing situation. If they're not an assisted living place, they can't offer CPR.

[HiPointDem]

116. Completely false, though you keep repeating it.

According to Joseph Rodrigues, California’s long-term care ombudsmen, “there’s no regulatory requirement for them [Glenwood Gardens] to provide CPR because they are not licensed to offer skilled or medical services to their residents. But from a moral perspective? It’s hard to say. I wouldn’t want to speculate without knowing the details.”

(i.e. they are not *required* to offer CPR, which is a different matter from them being *forbidden* to offer CPR).

A just-breaking statement released by the California Assisted Living Association (CALA) said, “Currently in California, regulations do not address CPR training or administration in independent living communities. While CALA’s membership is comprised of Assisted Living communities, not independent living communities, this incident is prompting providers to review their practices assuring appropriate emergency response procedures are in place.”

(i.e. the law does not *address* CPR = not forbidden or required).

http://blog.aarp.org/2013/03/04/sally-abrahms-nurse-who-refused-to-perform-cpr-on-independent-living-resident/

And the fact that other facilities in California *do* offer CPR to people in independent living pretty much demonstrates that it's not *forbidden by law,* as you keep repeating.


Russ Heimerich, spokesman for the California Board of Registered Nursing, said the question of responsibility depends on whether the woman on the 911 call is indeed a licensed nurse working in the capacity of a nurse.

Circumstances that could allow a medical professional to forgo performing CPR include cases in which life-saving resuscitation could expose the care provider to harm — or when there’s a “do not resuscitate” order on file.

But generally, “a nurse in that situation must perform CPR” or provide other appropriate medical care, Heimerich said.

The requirement to render aid is less clear in cases in which a trained nurse is hired to function in a different capacity. A nurse or other medical professional working as an administrator, for example, may not be held to the same standard, professionally, he said.

But Heimerich acknowledged there are professional standards, and then there are human ethics, the need to simply do the right thing.

http://www.bakersfieldcalifornian.com/local/x738926924/Police-probe-Glenwood-Gardens-death


Kern County’s long-term care ombudsman, Nona Tolentino, said people trying to choose a retirement home for their family member could easily get the impression that all residents of Glenwood Gardens get the same care — which she said is not the case.

“This is why I encourage people to be savvy consumers in looking for” a long-term care facility, Tolentino said, adding that she was “appalled” that no one would provide CPR to Bayless.

http://www.bakersfieldcalifornian.com/local/x738926924/Police-probe-Glenwood-Gardens-death


It has nothing to do with state law. It was the policy of this CORPORATION.

[HiPointDem]

121. as for your claim that it's different in wash, it looks like this corp has the same policy here:

The facility is owned by a company called Brookdale Senior Living, which has facilities in 36 states, including 12 in Washington. Many of those facilities -- including one in Lynnwood -- are under the Clare Bridge brand.

Nurses at the Lynnwood facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.

http://www.komonews.com/news/local/Assisted-living-nurses-not-required-to-give-CPR-to-dying-residents-195180431.html


So apparently this is the nationwide CORPORATE POLICY of BROOKDALE SENIOR LIVING.

So don't let your parents go there if you want them to get emergency aid, because the staff will just stand there and let them die even if they want emergency aid.

[dkf]

205. If you want the increased services you have to move to that section.

Or sometimes you must leave the facility and find one with a higher level of care.

[HiPointDem]

126. they don't need a license to give emergency aid. that is corporate policy, and this poster is

misrepresenting the situation.

[Thor_MN]

52. CPR is not medical care

No one, anywhere, can be sued for performing CPR, especially if instructed by a 911 operator.

[pnwmom]

78. CA law treats it as medical care and requires an license for it to be administered.

Apparently you're not aware that the Good Samaritan laws have some significant holes in them. If a person had a DNR and someone administered CPR, they could find themselves facing legal action. And they'd probably have to pay the bills for defending themselves even if they won the case.

[Thor_MN]

93. Care to prove that a random person adminstering CPR had knowledge of the DNR order?

Apparently you are unaware that gross negligence, willful misconduct or intent to harm would have to be proved. A case would last about two minutes, if anyone could find a lawyer willing to get their ass kicked out of court.

[HiPointDem]

117. bullshit. you keep repeating that california law forbids independent living facilities to give

cpr & it's pure bullshit.

[HiPointDem]

63. that's rather misleading. every assisted living or skilled nursing facility is licensed to give

medical care; medical care is part of the reason such facilities exist. there's little difference between california and washington in this respect.

the controversy arose because the woman didn't live in the assisted living or skilled section of the facility, but in the 'independent' section.

and as the other poster said, cpr isn't 'medical care'. anyone can give cpr in an emergency assuming they know how.

[pnwmom]

80. What is misleading? The woman lived in independent living, not assisted living or skilled nursing

They are in separate parts of the complex, each with its own staff.

Don't tell me anyone can give CPR -- tell the State of California, which has made it illegal for independent living facilities to have their employees do so.

The police have already investigated and said that no criminal charges will be forthcoming. And the woman's family said today that they won't be suing.

You can't charge someone with following the law. They need to change the law.

[HiPointDem]

100. All the staff works for the same corporation. Anyone can give cpr in an emergency. No criminal

charges will be forthcoming because the family says the woman didn't want cpr.

That doesn't mean this facility's policy is optimal and it doesn't mean this facility's policy is constrained because of "the law". It is not.

[pnwmom]

103. No, employees of a non-licensed independent care facility in CA may not give CPR.

Someone walking down the street could -- but an employee could not.

Criminal charges and civil charges are two different things, and the woman's wishes don't affect criminal charges.

(I read an article from a city called "Lincoln" -- don't know which state -- that said their state law called for a $10,000 penalty if a non-licensed home gave medical assistance, including CPR, to a resident.)

[HiPointDem]

108. Employees can't because the facility forbids it. The family's wishes in this case make a great deal

of difference about whether the authorities will pursue criminal charges against a facility which did not perform CPR on a patient WHO DID NOT WANT CPR.

i.e. there has been no *crime*.


Elmcroft Senior Living, though, has a different policy for its 103 facilities in 19 states, including those offering independent living, said an official of the Louisville, Ky.-based company.

"In the event a resident suffers cardiac or respiratory arrest, to the extent allowed under state law, our policy is to call 911 and perform CPR unless the resident has a do-not-resuscitate order," said Bob Goyette, Elmcroft's senior operations vice president. "That is a standard practice in the assisted living industry. Performing CPR at independent facilities — it's up to the facility."

http://www.usatoday.com/story/news/nation/2013/03/05/no-cpr-policy-common/1966111/

CPR is not 'medical care,' it's an emergency service that can be performed by members of the general public. It is not outlawed by the state of california, that's the facility's *interpretation* of the licensing requirement.

[pnwmom]

110. The law could easily be changed to require it and that's what should happen. n/t

[HiPointDem]

111. The law does not forbid it. It's the facility's *interpretation* of the law.

Elmcroft senior living, which *does* give cpr to independent living residents unless they have a dnr, has independent living facilities in california.

http://www.elmcroft.com/community/las-villas-del-norte/

[HiPointDem]

139. no.

[enlightenment]

9. I think it is their choice.

My elderly father lived another 9 years thanks to rapid intervention after a sudden and devastating cardiac event at 81. He appreciated those years, so though I never asked him if he thought it was worth it, I imagine he probably did.

That certainly may not apply in all cases, but I really do not like the sweeping nature of a question like "Should a frail, elderly person receive CPR?" I agree with Dr. John's assessment - and that of the author of the piece. The decision should rest in the hands of the individual. Rather than deciding that there is some age at which people should be "allowed" to die by withholding treatment without their consent, we should be having the conversation - open and often - about the importance of making end of life decisions before someone else has to make them for us.

[pnwmom]

14. I agree. n/t

[oregonjen]

11. I thought that another reason to administer CPR was to circulate oxygen

[pnwmom]

19. Yes, in the hopes that doctors could get the heart working again.

It's only a stop-gap measure in that case.

[FSogol]

55. You are correct. My cpr instructor discussed a case where a group took turns performing cpr

on a patient for 30 minutes until paramedics arrived and revived the patient.

Additionally, the amount of misinformation about cpr in this thread is scandalous.

It really sucks to see people here promoting not making the attempt to revive someone.

[HiPointDem]

65. 'let them die'. they're old and useless. i'd say that's the general sentiment. however, i guess

it's been clarified that the woman didn't want lifesaving measures in the event of a crisis, or so the family says. so that part's fine.

i wonder though if folks living in the 'independent' section do so with the knowledge that even if they *do* want cpr, the folks running the place won't give it to them if they have an emergency?

seems to me that should be stated clearly before you pay your fucking 2500 a month to live in the place. no different from living in an apartment, imo, except that your neighbors might give you cpr.

[nadinbrzezinski]

86. I was a CPR instructor for EMS personnel

There are factors that influence survival rates. Among them are age, general health, and what is the cause of the code. Yup, we once gave CPR to a patient who was hypothermic and had been clinically dead for at least twenty minutes. It was the first time those protocols were used in fact...the patient not only was brought back, at the trauma bay, forty five minutes later, over 60 minutes of being dead...but walked out of the hospital and went to live a long life. There was no neurological effect any of us could speak off. His starting temp was in the 70s...

This, like the case you describe, is actually the exception not the rule.

As I used to tell my students, you will start the code and work it until told to stop...but depending on a slew of circumstances actual saves outside a hospital setting are rare. Saves inside a hospital setting are less rare...and with the elderly they are rare regardless. Witnessed codes have a better chance as well, when compared to non witnessed codes.

This is not tv.

That said, we still try. But knowing that CPR is a last ditch measure that fails more often than not is not saying don't even try. It is recognizing reality.

[MADem]

195. Upthread I posted a link to a situation where a bunch of people kept going for ninety six minutes.

The guy lived, he's fine, he's grateful.

I too, think it sucks that this "Kill off the Geezers" attitude is being shopped. It smells like it's coming right out of "Corporate For Profit Medicine."

[HiPointDem]

201. rather vigorously promoting it. to the extent of pushing false information and straw men.

[Buzz Clik]

12. Let them die. Why risk broken ribs?

[pnwmom]

16. How about "let them choose" before they're in that situation?

That's the point of having a health care directive.

My 84 year old mother has her DNR posted prominently in a few places in her house, in case anyone ever calls 911 on her. My mother-in-law would never have done that.

[Buzz Clik]

18. Sounds like a wise plan.

[Hekate]

56. Same here. Mom posted her wishes on the wall by her phone; mother in law would never ever discuss...

... last wishes. I have to say my mother was a tough and in-your-face old bird, but she sure knew what she did and did not want in the way of dying.

My poor MIL had her big stroke in her 90s, and her 3 sons could not agree to any course of action, so she left the hospital with a feeding tube and spent the last almost-year of her life unable to communicate or move at all, being diapered and fed by tube. When I finally, finally got a DNR from the doctor (iirc both my husband and the doc had to sign it) I put it in a Ziploc bag and wired it to her bedframe. The poor woman finally died in her sleep, so that point was moot.

[pnwmom]

89. Sorry you had to go through that.

I posted above about a friend I had whose relative was unresponsive and connected to tubes in a nursing home, for five years till she died at 105. And no one had the strength to sign a DNR, so the nursing home called 911 four times in her last five years, sending her to the hospital to get her heart going again . .. so she could go back to the nursing home and continue to be non-responsive, eating out of tubes.

[Hekate]

94. Had a terrible fight with a friend over the issue of the feeding tube

We've never been the same since. See, she's my age but her husband was 20 years older. He was in his 70s when he had his stroke, and was given a feeding tube for a couple of months. He got so he could swallow again, and the tube was removed. When I told my friend that I had been opposed to my MIL's feeding tube from the start, she just went ballistic on me -- took it very, very personally, and could not understand that I was making a clear distinction between their respective ages and conditions. Mind you, this altercation was after both persons were deceased...

His condition was NEVER as bad as my mother-in-law's and he was over 20 years younger than my MIL. He could speak well, could move about though not walk, and enjoyed a good relationship with his family. All things considered, a fairly good quality of life. He lived another 3 years, and I think died of pneumonia.

We're all in our mid-60s now, and genuinely the older generation ourselves. The "circle of life" ain't all hearts and flowers.

[bemildred]

20. "First, do no harm."

This dogma sems to be failing that metric.

[pnwmom]

22. What dogma?

The CA law that requires a special license before a facility can offer CPR?

[bemildred]

25. The dogma that says you must give CPR to the elderly to "revive" them.

And I would hazard that the fear of being sued is mixed in there too.

[pnwmom]

29. I know of a woman who died at the age of 105

after spending her last 5 years unresponsive, hooked up to tubes, in a nursing home.

The grandchild that was in charge of her care couldn't deal with the responsibility of signing a DNR, so that poor woman got rushed to the hospital 4 times in her last few years to get her heart going again.

It was the saddest thing.

She was a medicaid patient and I wondered if that was another incentive for the nursing home to keep her going.

[bemildred]

31. Yes.

Money comes to mind, incentive-wise, one becomes a real cash cow at the end. I know, we aren't supposed to think such things, but I look at our health care system and I do.

I've seen it too, my brother, but we took him back when he was ready to go and got him into hospice care. He was 60, in his case I would have had no problem with breaking his ribs, but for the liver cancer.

[Warpy]

107. It's not just money

If you've ever been intubated and on a vent, you know it hurts. So do chest compressions and defibrillation. So do getting IVs and central lines put in and maintained so drips to control heart rhythm can be administered.

We're torturing some of these old people because the families just don't understands "do everything" does not increase their quality of life and most of the time, it doesn't buy them any more than a few days or weeks of constant pain.

Breaking the ribs and sternum are bad enough, but the broken bones then do additional damage, like lacerating lungs and liver and sometimes the heart you're trying to save.

CPR is incredibly violent to old folks with brittle bones. It also works very poorly on frail elderly patients. When it does work, it sets them up to finish their lives in horrible pain.

I would very much like to see "no CPR" standard for all elderly and debilitated patients. Electroshock, yes, drugs yes. Just don't do the compressions that do so much damage.

I sure as hell don't want it done to me.

[MADem]

138. How horrible! No CPR--standard? The "default?" Do you really mean that?

I found the comments from a respondent (who apparently didn't want her elderly husband to be shuffled off this mortal coil, despite his age) to the article posted in the OP very interesting:

Carol Eblen Kansas City, MO
@Paula Span As to unilateral DNRs. It was one of the leading scholars and experts concerning "medical futility and the law" Professor Thadious Pope of Hamline University who indicated that a physician in a Hospital in San Francisco ( where he was "consulting" ) had placed DNRs in all of her patients' charts. When asked why? She apparently said "because they haven't yet made up their minds" or words to this effect.

I was brought to this subject matter because of an illegal and unauthorized DNR placed in the chart of my elderly husband for the purpose, we believed, of capping the costs of his care because the hospital and the physician knew that they wouldn't be reimbursed for his care, and, of course, he was going to die anyway in the not too distant future.

There have been many articles written on the OVERTREATMENT of patients for profit and there have been many articles written on the GREAT costs to Medicare and the private insurers of inpatient medical care for ELDERLY patients at the ends of their lives.

Hospice as a Medicare entitlement came about in 1986 and the PSDA in 1991, and yet you say it is NOT public policy to encourage elderly patients to shorten their lives in their best interests --and just coincidentally save all of this money for Medicare and the private insurers?
Aug. 15, 2012 at 2:05 a.m.

http://newoldage.blogs.nytimes.com/2012/08/10/more-on-cpr-for-the-elderly/


This is a horrible shift in thinking being shopped here, under the guise of being "kinder to the geezers" when it's actually a cost-saving measure by corporate medicine--I don't like it one bit, I must say.

[bemildred]

150. Yeah, I'm 68 and I really mean that.

We're all going to die, the questions are how and when, not if. If you want somebody else deciding that for you, go for it.

[MADem]

188. Well, if "no CPR" is the default, someone else IS deciding when you die.

To have to actively demand CPR (when you're in no position to do that) is a bit problematic.

I'll wager most of the people in that facility had no idea that no one would help them if they needed CPR, unless they actively asked.

In most situations, if you don't want treatment, you say so.

[Warpy]

177. Have you ever cared for an 85 year old with a chest full of broken ribs

who's on a ventilator and unlikely to come off it?

I have.

I know people are afraid of dying. Some things are worse.

[MADem]

186. I'm sorry. I just don't buy that logic. I think it's pretty awful, actually.

Bones heal. Death is forever.

Just because people are "old" does not mean they should be discarded or given worse care because of their age.

When it's your turn, I wonder if you'll want them to just leave you there to croak?

I happen to really enjoy living--I look forward to each and every day. It's a wonderful thing, life--something to be treasured and savored and if there's any way to hang on a bit longer, I'm all for it. I'll tolerate pain, if needs must, to keep on staying alive, too.

These people, I am sure, are glad that no one said "Oh well, we might break a bone, so fuck 'em."

http://eb.gmnews.com/news/2012-02-16/Bulletin_Board/EB_Rescue_Squad_applauds_police_for_help_in_CPR_sa.html
http://articles.chicagotribune.com/2012-12-03/news/chi-sergeant-credited-with-saving-life-of-woman-84-20121202_1_police-sergeant-stable-condition-heart-attack
http://abcnews.go.com/blogs/health/2011/12/23/hero-teen-uses-cpr-to-revive-elderly-man/
http://fire.ucdavis.edu/news/reflecting-back-one-year-later-gary-colberg-saved-by-bystander-cpr
http://www.redcross.org/news/article/Co-Workers-Save-Mans-Life-With-CPR-AED

Maybe they should have given up on this guy, too--an hour and a half, maybe they might break a bone?
http://abcnews.go.com/Health/96-minute-cpr-marathon-saves-minnesota-mans-life/story?id=13048099

I hope if I'm ever in a situation where I need CPR, that you're not making the decision. Your bias is deeply concerning to me.

[Warpy]

187. You might have read my whole post, you know

Broken bones are only part of it.

[MADem]

189. Well, I did read your post, and not every case--see the examples I provided, that you did not read--

involves dire medical consequences. Some people, even elderly ones, don't break bones. Some don't need tubes. Some get up, feel a bit sore, and go home and live many more years.

You take the worst case scenario and apply the "Aw, fuckit" attitude. I don't care for that approach.

I agree with this doctor:

But Dr. John, a 20-year emergency medicine veteran now practicing at Johnson Memorial Medical Center in Stafford Springs, Conn., argues that the risk of brain damage with CPR is small and can arise in patients of any age. He sees the pain of broken ribs as a small price for staying alive.

“If you’re a reasonably healthy and functioning older adult, there’s no reason to withhold CPR,” Dr. John said. He’s 58, and he said, “If I’m in a supermarket and I go down, and there’s an external defibrillator and someone grabs it and shocks me within two minutes, I’m going home.”

And if an older person’s brain has lost oxygen for too long? “If he doesn’t benefit, he doesn’t lose anything,” Dr. John said. “You can make that decision the next day” – meaning, his family can ask to have the life support equipment in the intensive care unit discontinued. Or, he said, “people can make decisions on their own ahead of time by not calling 911.”

But the bottom line for Dr. John, who estimates that he’s resuscitated 300 to 400 people: “I’d give CPR a shot.”

http://newoldage.blogs.nytimes.com/2012/08/10/more-on-cpr-for-the-elderly/

[HiPointDem]

66. and i know a woman who died at 98 and spent the last years of her life taking a daily walk around

the part & driving to get her own groceries.

so the hell what?

[pnwmom]

76. So . . .

every case is individual, and should be treated as such. (And the 105 year old I knew was poorly served by the decisions people were making about her care.)

In the case of the CA woman, her daughter said that she probably would have died even if she'd had CPR. And they say she had chosen to live in a facility without medical care.

I'm not surprised because my mother-in-law was very proud of taking care of herself in the independent living part of her retirement residence. (She eventually died in hospice of cancer.)


http://www.usatoday.com/story/news/nation/2013/03/05/no-cpr-policy-common/1966111/


Bayless' family said Tuesday in a statement to The Associated Press that she had chosen to live in a facility without medical staff and wanted to pass away without life-prolonging intervention. The family said that it does not plan to sue the independent living facility.

[HiPointDem]

101. I agree, every case is individual. That's why the blanket policy that no emergency aid will be

given is wrong.

[pnwmom]

109. Why is it wrong if residents are fully informed and consenting, as this woman's family said she was?

[HiPointDem]

122. It's fine if they are. It's fine in this woman's case. It's not fine to have a blanket policy

that forbids staff from rendering emergency aid to *everyone* and allows them to stand by while someone who wants emergency assistance dies.

[MADem]

143. I agree--the "default" should be to give care, not to refuse to give it.

If people don't want it, they can put a sticker on their door, or something.

Like letting a fireman know you have a pet in the house...

[MADem]

141. Reminds me of my neighbor's mother. Just the same, minus the driving.

She died a week or so before her 100th birthday. Her kids were so pissed off; the mom was looking forward to the "paaahteee." They had it anyway, it was her funeral, but they really wished she could have made that milestone.

[GaYellowDawg]

136. "Revive" them. Yeah, I'm sure they're pissed off about being "alive."

I'm sure when they "wake up" in a hospital room, still "alive," and know that they're "alive" instead of "in a casket," they're pretty fucking "grateful." Aren't "quote marks" wonderful?

By the way, if "first, do no harm" meant "don't risk treatment if there's not an excellent chance of success" as you seem to think, then a whole lot more people would die a whole lot sooner.

[bemildred]

149. So I hit a nerve, eh? nt

[GaYellowDawg]

153. A consequence of posting something so thoroughly unfeeling.

And stupid.

[bemildred]

154. Name calling isn't much of an argument either. nt

[HiPointDem]

155. the poster didn't call you any names.

[bemildred]

156. I didn't say he did. I said he made no argument, he just used insults. nt

[HiPointDem]

159. he made an argument. his argument was that your scare quotes around 'revive,' as though

cpr for old people was something other than 'revive', was stupid and unfeeling. that's why he used 'sarcasm' & 'mockery' in his 'argument'.

your 'argument' wasn't rocket science and didn't necessitate any detailed argument other than mockery.

[bemildred]

161. Those are "bullshit" quotes. When the "success" rate is 20% for an otherwise harmful treatment,

those quotes are quite appropriate. It is all very well when the patient is competent and agrees, it is quite another thing when it is inflicted without consent, as it often is. If it is not a problem, why are people taking extraordinary measures to avoid it?

[HiPointDem]

163. the success rate is 20% for everyone. so i presume you are against cpr for anyone, since the

success rate is small, & few people give notice of their wishes re cpr before its needed.

and ps: they're called scare quotes.

http://en.wikipedia.org/wiki/Scare_quotes

[bemildred]

164. Presume away, I don't give a shit what you presume. Go read post #157. nt

[bemildred]

162. Here, read this:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2468039

[HiPointDem]

166. i read it. what golden nuggets am i supposed to draw from it? it pushes a red herring, in

that it makes an argument that someone is preventing old people from their 'choice' not to have cpr done, when the issue in this case is that this corporation's BLANKET POLICY is that CPR will not be done at all.

this corporation is the largest of its type in the country, with nearly 700 facilities.

making residence dependent on giving up the normal presumption of emergency assistance is bullshit.

and as the facility didn't even *know* the woman was DNR at the time of the incident, so is all the talk about her 'choice'. The corporation had a blanket policy not to give emergency aid.

[bemildred]

167. The corporations policiies differed by facility. There were nearby facilites where CPR is done.

The "victim" was living in the no care facility. The family has stated that the "victim" was well-aware of where she was, and that is why she was there.

http://www.foxnews.com/us/2013/03/05/spokesman-says-woman-who-refused-to-give-cpr-to-dying-87-year-old-wasnt-nurse/

The family of an 87-year-old woman who died after an employee denied to give her CPR at a California independent living home says she chose to live in a facility without medical staff and wanted to pass away without life-prolonging intervention.

Lorraine Bayless' death last week at Glendale Gardens, a Bakersfield independent living facility, prompted outrage after a 7-minute recording of the 911 call was released. Brookdale Senior Living, which owns the facility, initially said its employee acted correctly by waiting until emergency personnel arrived. But late Tuesday, it issued a new statement saying the employee had misinterpreted the company's guidelines and was on voluntary leave while the case is investigated.

"This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents," the Tennessee-based company said.

Meantime, shortly before Brookdale's clarification, Bayless' family sent The Associated Press a statement saying she was aware that Glenwood Gardens did not offer trained medical staff, but opted to live there anyway.

[HiPointDem]

169. bullshit. you don't even know the basic facts of the case.

1. 'No emergency aid' is the BLANKET POLICY of Brookdale Senior Living, the corporation that owns Glenwood Gardens and nearly 700 other facilities in 36 states, for all its independent living facilities.

The facility is owned by a company called Brookdale Senior Living, which has facilities in 36 states, including 12 in Washington. Many of those facilities -- including one in Lynnwood -- are under the Clare Bridge brand.

Nurses at the Lynnwood facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.

http://www.komonews.com/news/local/Assisted-living-nurses-not-required-to-give-CPR-to-dying-residents-195180431.html

2. The facility did not make the EMT responders aware of the woman's DNR status, because they DID CPR:

Bayless did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.

http://www.komonews.com/news/national/Woman-dies-after-nurse-refuses-to-do-CPR-194834281.html

Which suggests she either didn't have one, or there was no protocol to make it readily available, or the staff really didn't give a shit about whether she got CPR or not, just that *they* wouldn't be the ones to do it.

So she got CPR regardless of her supposed directive.


3. As there were at least two official statements (one from the director of the facility, one from corporate HQ) that the nurse had followed the correct protocol, but now (after lots of flak) the corporation is saying she didn't, the logical conclusion is that the nurse is being made the scapegoat for following corporate policy. As your own linked excerpt makes clear:

Brookdale Senior Living, which owns the facility, initially said its employee acted correctly by waiting until emergency personnel arrived. But late Tuesday, it issued a new statement saying the employee had misinterpreted the company's guidelines and was on voluntary leave while the case is investigated.

[bemildred]

170. So the families statement means nothing to you? Got it.

I don't care about the butt-covering of those bureaucrats or their little squabbles about who to blame.

[HiPointDem]

172. The family's statement has nothing to do with the issue in this case, which is not the fate of this

particular woman.

The butt-covering of the corporation and its blanket requirement that one give up one's right to standard emergency aid to enter a 'retirement living' facility *is* the issue.

As is the attempt to promote the meme that old people shouldn't get emergency aid.

But thanks for the latest straw man.

[bemildred]

173. I will talk about any issue I choose here.

You don't decide what the issue is, any more than anybody else.

My issue is that woman's right to get the care she wanted and paid for. Having watched several family members die now, there is very litte else I do care about, unless that is addressed first.

[HiPointDem]

174. it's obviously is not your only issue, as you've posted that you'd like to see "no cpr" as

the standard of care for the elderly.

and this woman GOT CPR, despite her supposed directive, apparently due to the negligence or disorganization of this facility. a fact which you keep ignoring.

she just got it from the emts, who would not have given it if they'd been informed of the DNR order.

so apparently your concern is not actually for the woman getting what she wanted either, just in promoting the idea of 'no cpr for old people'.

[bemildred]

179. Yeah, I like to kill puppies too:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2468369

[bemildred]

180. By the way, can you post a link to the statement you claim I made?

I'm afraid I don't see it anywhere.

[HiPointDem]

181. In response to this post:

138. How horrible! No CPR--standard? The "default?" Do you really mean that?

You posted:

bemildred (66,160 posts)

150. Yeah, I'm 68 and I really mean that.

[bemildred]

182. Ah, I meant for me, no physicians should not make those decisions Edit: unilaterally. nt

[HiPointDem]

183. i accept that you may have meant only yourself. however, the question is about the standard

of care for *everyone,* with 'no cpr' as the default, and its quite clear.

[bemildred]

184. Yes, that's what it says there.

The truth is it just never occurred to me anyone would say something that stupid, "no CPR" as a blanket rule for everyone.

In the context of a care facility marketed on that premise, however, I don't see the problem.

[HiPointDem]

203. i see a great deal wrong with the largest corporate provider of 'senior living' requiring that you

sign away your right to emergency assistance as a condition of living in their facilities. What would be the reason for a corporation to make such a stipulation? What is the point of it?

[bemildred]

207. But that is not the case. There is no such requirement, nobody is compelled. nt

[MADem]

197. The family's comments shouldn't be controlling anyway. This woman lived independently.

She wasn't a ward of the state or dull of comprehension and needing supervision.

What "controls" is what's in her medical record or on file at the facility office. If she didn't want to be revived, a "medic alert" bracelet or pendant stating that would be a great fashion accessory.

I don't agree with "Fuck it, that's an old one, leave 'em on the ground to die," and that IS what is being shopped here. It's Corporate Medicine, trying to sell an idea to 'late boomers' and younger who haven't quite felt the hand of mortality on their shoulder, and who don't realize that when they get a bit older they may discover they aren't ready to check out without someone putting a little effort towards keeping 'em here for a bit longer.

It's real easy, too, to say, "Aww, to hell with them, they're OLD, they've lived long enough," when it's just some strange old geezer...a different thing when it's your golfing and vigorous father or yard-saling and church choir-ing mamma.

Most people WANT to live. If they were ready to go, they'd swallow a load of pills, or lock themselves in the garage with the car running.

[Codeine]

21. You can break every rib I've got if it might save my life.

Living is awesome, and beats the shit outta dying.

[pnwmom]

24. How many 80 or 90 somethings do you think would say that,

knowing the probability of "success" was so low?

[Hatchling]

59. The two 80-90s I know.

Adore thier lives. One of them asked who you thought you were trying to make that unilateral decision for them.
He said if a person doesn't want to live any more they have plenty of options.

[pnwmom]

77. Then they should be glad that it was this woman's decision to live in this place

and that she knew it didn't offer medical care, and that she wanted to die a natural death.

[jberryhill]

28. "beats the shit outta dying"

Why, have you tried it?

[mucifer]

30. You have to think about the underlying cause. I tell my hospice patients and their

families that CPR does not cure end stage cancer and I try to describe to them how ugly CPR and ventilators can be and that it is can be the difference between holding the person who is dying in your arms and watching the last breath or the person being surrounded by strangers poking them with needles and sticking tubes down their throat.

But, Ultimately, it's not my choice.

Children with neurologic or cardiac deficits can come back and live for a long time on ventilators. They are making the ventilators stronger and fancier and sometimes I wonder about that. I think it can cause a lot of suffering.

[pnwmom]

34. These issues are so complicated and that's why

no one can be deciding them for anyone else, or for their families.

[HiPointDem]

124. yet this corporation has a BLANKET POLICY that decides for everyone.

[cui bono]

45. I also heard that your body fights any respiratory machine.

Can't explain it now but it was in a Radiolab podcast i just listened to a few days ago which was about this and a doctor explained it.

http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/

[mucifer]

47. Yes, they usually have to sedate people at least at first.

[cui bono]

53. Yeah, and sometimes even paralyze!

[nadinbrzezinski]

105. To get the tube down we used paralytic s

Patients are sometimes aware and scared shitless. But...that airway at times has to be secured.

If people understood. I heard your thing on doctors and heroic meassures...I am with them. Give me pain meds, heroic meassures, not so much.

[DeschutesRiver]

168. Just listened to that a few days ago. It really gave me a lot to think about on this subject.

For one, I hadn't realized that the odds of regaining one's normal life after CPR (esp. when you are older) were so poor; iirc, it was around 8%, and of those, only 3% regained their normal lives and abilities.

I am going to research it more, but am appalled by the difference between what we all think happens after a "successful" CPR intervention and what actually does happen for most people. And esp. those of us who are older and getting older still every year - I had dh listen too and we are discussing how we can best choose to die a good death, if possible, in certain circumstances. It is time to have this discussion, given our ages.

You may have gone there already, but on the WYNC website there are some comments on this Bitter End podcast that are also interesting to read!

[postulater]

33. I had to do the Heimlich at home this morning before work.

A stone was lodged in her throat. She was struggling to dislodge it and having great difficulty breathing.

I had to get the net and scoop her out of the tank. I could see the stone deep in her throat and when I squeezed her sides it dislodged enough for me to grab it.

Luckily I was there to help her, she had no DNR order and I think it is ok with her that I saved her life.

She's twelve years old. And goldfish have been known to live a long time.

[Codeine]

35. The weird thing is that I've done that myself.

A betta I had years ago got a piece of errant plastic from the filter lodged back in its mouth. A quick squeeze popped it right out and he was good as new.

[pnwmom]

37. Wow.

I assumed you were talking about a dog, but I wondered why the dog would eat a stone.

I'm still wondering why a fish would eat a stone -- probably showing my ignorance here.

Congrats on your successful Heimlich!

[cui bono]

51. Not sure if you're kidding or not, but I used to have to watch my dog eat as he had

a tendency to choke on his food and there were a few occasions where I gave him the Heimlich. My sweet pit bull... <3

[postulater]

73. Not kidding. Just lucky I was there or she'd be dead now.

I just got home and it looks like she has recovered fully.

Sounds like your dog needed a liquid diet!

[Kingofalldems]

38. My heart stopped 9 times

when I had a heart attack 4 yrs. ago, even during an emergency stent procedure. CPR worked for me.

[pnwmom]

40. Yay!

Glad you were a success story.

We just lost a friend to a heart attack in a hospital, after having a fairly routine out-patient procedure. So I know it doesn't always work.

[Kingofalldems]

71. After reading th OP I am even more amazed that I am still around.

Gives me chills. Now it is clearer why I became a mini celebrity while in the cardiac unit. Nurses were coming to visit, one just wanted to touch my hand.

[pnwmom]

75. You were definitely a success story, and doctors and nurses never become immune

to the joy of helping one to happen.

[liberal_at_heart]

48. I'm glad CPR worked for you.

I know I would want CPR. If it didn't work then my suffering would be over soon enough. If it did work then I would get to live longer.

[Kingofalldems]

69. I know from experience that when your heart stops

you don't feel a thing.

[JustABozoOnThisBus]

148. Yeah, but are you 87 years old?

Today, I'd want CPR. But I know my father would not. Both wishes are valid.

[cui bono]

41. That's why 80% of doctors DO NOT want CPR performed on them.

I just listened to a Radiolab podcast that talked about this. They talked about a Johns Hopkins Precursors Study that asked a lot of non-doctors what they would want done to try to save their lives and also asked doctors. While non-doctors wanted pretty much everything done, doctors mostly did not want anything done. They know the statistics and they don't think it's worth the pain and suffering to not get much more life from it. The one thing most of the doctors did want was pain medicine, to give them some comfort as they passed.

It's a great listen, here's the link:
http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/

There's some good links on that page as well.

[liberal_at_heart]

44. How can you possibly know if the medical crisis you are going through is fatal?

[cui bono]

46. There are statistics as to the success of certain prodedures, and that's why the doctors answered

the way they did. They see it first hand.

You don't know about any particular instance, but they have considered the cost/benefits and the great majority of them decided against most of those procedures. Listen to the show, it's short and well worth it. I found it fascinating to hear that most doctors would not opt for all the procedures.

[pnwmom]

83. If you are suffering from terminal cancer you HOPE it might be fatal.

Lots of cancer patients would rather die of a simple heart attack.

[HiPointDem]

68. link to that study, please? no, not to the radio show, to the study.

[Revanchist]

42. Frontline had a program called Living Old a few years back

After watching it, I really don't think I'd want CPR performed on me at a very advanced age.

You can watch it online here

http://www.pbs.org/wgbh/pages/frontline/livingold/view/

[pnwmom]

84. Thanks for the link.

I don't think I would, either.

[Hekate]

49. When my FIL was in a nursing home they had to ask us about a DNR

The poor old guy was in his late 90s and out of it. My BIL stalked out of the meeting saying "You're not going to kill my father." My MIL dithered and couldn't make up her mind, which meant no, and my husband couldn't go against his mother.

Months passed. They called us in again and said they were out of compliance and at risk by not having some form of direction in writing. My BIL was not there that time. So I spoke up and laid it on thick. I asked DH and MIL if they wanted Pop to have a peaceful passing or if they wanted his last experiences on this Earth to be of people shouting at him, pounding his chest, breaking his bones, sirens, lights, etc etc. Because that is what CPR in your late 90s would amount to: a useless and cruel exercise.

The family finally signed the DNR.

Believe me, that is what I thought of when the news broke at DU about the woman in her 80s whose caregivers refused to give her CPR. I do not know the details because some threads are not worth getting into, but on the face of it I just said, "For Gods' sake, what do people want? The woman's heart stopped in her late 80s. It's called dying of old age."

[CTyankee]

54. when my mother was frail, ill and 94 years old, I refused to have her transferred to another

hospital because of a stupid regulation to get her out. I knew it would kill her in the transfer. She did die that night, peacefully and gently in her hospital bed with me by her side. Lifting her out and putting her down into a gurney would have been agony for her and I would not have it. Mercifully, she would not live long enough for that to have happen.

I recall that moment in 2005 when I read about CPR resuscitations. Are they always the only way for everyone?

[HiPointDem]

72. people should make their own decisions about what they want, and review them yearly. the

point is that the facility shouldn't have a blanket policy (or if it does, that policy should be made explicit to residents and families, so that they would know that this 'independent' retirement living offers nothing more than an expensive apartment does.)

You did what you thought was right for your mother and it worked out for the best. what if your mother had been 68 with mobility problems, but still mentally sharp? would you have still wanted them to just let her die?

[CTyankee]

74. No, of course not. My mother was extremely old and frail at that point. She was essentially starving

herself to death. It is not uncommon. So she was a shell, actually. She was 94! I recoiled horrifically at her being lifted and moved. She was too fragile. How could I let that happen to her? I was the only one left to make that decision and I made it. It was the right thing to do. I honored my mother that night...

[HiPointDem]

98. I agree, you did the right thing by your mother. But my larger point is that not everyone living in

this type of arrangement is like your mother and I am not sure that everyone living in this time of arrangement understands that basic emergency aid will not be provided, even if you want it.

[CTyankee]

131. I never said it should be everyone's decision. depends on circumstances...

[HiPointDem]

132. i didn't mean to imply that you did.

[pnwmom]

90. The family said they and the woman knew what the policy was, and she wanted to die a natural death.

[HiPointDem]

97. I understand this family said the woman didn't want cpr. I did not see any statement that she

"knew what the policy was," & even if she did, that doesn't negate the point that people should know very clearly when they enter a facility like this that they will not receive basic emergency aid in a life-threatening emergency, despite paying about $2500 a month for the privilege of living in a 1-room apartment.

Do you disagree?

[JVS]

175. Even making your own decision ahead of time isn't always adequate. A DNR doesn't guarantee...

a restful death. My personal experience with this matter is as follows.

When I was 15 my grandmother had a stroke which turned out to be the first in a series of nearly annual episodes that would eventually kill her. The first stroke took away her ability to live by herself, so we moved her into our house and that was fine. She'd spend the days watching TV, or sitting in the front lawn, and frequently asking for a cigarette (she had quit smoking nearly 30 years earlier but her dementia had evidently made her forget about that).

A year or two later she had another stroke. She could no longer walk without help and we had to move her into the local nursing home a few minutes from our house. Between the facts that she generally was very agitated in the hospital during these crises (she'd yank her IV, try to leave the bed, etc), and the fact that nobody wanted to see her become a machine-bound vegetable, we had a DNR made. We figured that another run to the hospital would be traumatic and we didn't want to subject her to that.

A year or so later, when I was 18, she was having a heart attack and my mom called me up on the phone to tell me to come to the nursing home. When I got there she was in bed, conscious, nauseous, grunting a lot in pain, and her lips were taking on a bluish tint. My mom was having a tough time deciding what to do. After all they had made a DNR and if we called the ambulance they would start resuscitation on the other hand seeing her mom on the bed like a fish out of water was not an acceptable situation. The doctors made it clear that it was all or nothing; We decided to override the DNR and get her an ambulance. She died within the next 24 hours, but when we caught up to her at the hospital she was comfortable and in much better spirits than she had been at the home. We were glad though that we didn't follow the DNR and let her spend hours expiring on the bed in the home. There is no substitute for having people who care for your well-being and can adjust the approach based on circumstances.

[HiPointDem]

176. another reason blanket policies made by corporations = wrong

[pnwmom]

82. If you have a living will or a health care proxy you can direct a DNR order. n/t

[reflection]

165. Putting the discussion to the side,

I just wanted to say I'm sorry. I haven't gone through that but stories like that still make me tear up.

[Thor_MN]

57. I just turned 50, feel free to break my ribs.

I might have a different opinion if I arrest at age 98, while in bed with my 23 year old 4th wife, but for now, get me on the floor and thump my chest.

[REP]

58. I've known about this for a long time ... but ...

there's always a but: my very healthy vegetarian, biking, hiking, all-around clean living neighbor dropped one day from a heart attack when she was 42. Fortunately, she was outside and a neighbor saw her drop and both called 911 and did CPR. She survived; well, more than that, she made a full recovery. But this was a younger person with no previously known health problems.

My mother recently spent a month in the hospital and then 8 weeks in a nursing home. She has a DNR.

[pnwmom]

91. Right -- every decision depends on the person and circumstances. n/t

[REP]

160. Absolutely. More information = more informed decisions

My mother isn't particularly worried about cracked ribs (though that would be just another thing making a stay at a nursing home unbearable) when she signed a DNR; before her nearly deadly illness, she thought she'd want "heroic measures" but since being on a nasogastric tube, in an ICU, and then a nursing home, etc she's sure she does not.

[WilliamPitt]

60. An anti-CPR thread.

Had to happen sooner or later.

[Egalitarian Thug]

64. Simply stunning.

Talk about your, "WTF are you thinking?", moments...

[LisaL]

67. It's not an "anti-CPR thread.

It's a thread against doing CPR to someone who doesn't want it done.

[pnwmom]

87. Thanks, Lisa, that's what it is.

I wanted people to realize that CPR isn't the best for EVERYONE, and that we all have a CHOICE.

In the case of the CA woman, her family said today that she wanted a natural death and that when she entered the independent living facility, she knew she was only getting a place to live and meals -- not medical care.

[AnotherMcIntosh]

104. There are a lot of posters on this site and on this thread who don't want anyone to make choices.

Too many seem to be angry that others might make decisions contrary to theirs.

[pnwmom]

106. And I think a lot of them might be younger people

who haven't had to learn about all these things through life experience.

Most people don't learn about the differences between retirement communities, assisted-living, Alzheimer's caregiving, skilled nursing, and continuing-care-communities till they absolutely have to!

And when you're young, it's probably hard to imagine the mindset of an elderly person who has decided she would rather not have measures taken to extend her life.

[HiPointDem]

123. I am not a younger person. I am an older person who has watched many people die and works

in health care including nursing home consults.

If the person has a dnr order then obviously one would not render emergency aid.

You have been defending a blanket policy of not rendering emergency aid to ANYONE. Solely because they're OLD and in an independent living facility.

Defending it quite persistently and insisting that california state law MANDATES such a policy. which it DOESN'T.

[MADem]

144. I am no spring chicken myself, and I have a lot of "geezer" friends/acquaintances.

I drive them by the dozens to the polls every election day (looking forward to the upcoming "special" primary for Kerry's seat next month). They are mostly in their eighties and nineties, and they enjoy their lives. Some are on walkers, a few in wheelchairs, but they like their friends, their TV, their card games, their exercise classes, their outings as a group--and I am quite confident that they would find a "DNR as Default" policy shitty in the extreme.

Where there's life, there's hope.

I do think this theme is being shopped by corporate medicine as a way to make it "acceptable" to the public to not try to keep Granny alive, "for her own good," of course. The actual beneficiary of this policy is the health care industry, because sick old people suck up a lot of that health care industry profit margin.

[HiPointDem]

146. I agree that this meme is being shopped, and that's why this thread pisses me off so much.

It's true that medical care can become a horrorshow of useless 'care'. But a blanket policy of no emergency aid is also a horrorshow, and in a worse way. It has the stink of eugenics about it, and so does this thread.

This is the biggest 'senior retirement living' corporation in the country, with over 600 facilities. That it would have a blanket policy of no emergency aid is disgusting. I'm glad they're getting slammed on facebook and yelp, etc.

[MADem]

147. I'm thinking my older friends will prefer to just stay in their homes and rely on the "I've fallen

and I can't get up" pendants and wristbands!

[HiPointDem]

113. actually, i think everyone is fine with people making choices, but against corporations making

blanket choices about life and death and especially when they charge $2500 a month for it.

[AnotherMcIntosh]

118. "everyone is fine with people making choices"? How could you think that if you've read the posts?

[HiPointDem]

119. show me the post where someone says "they should give cpr even if the person has a dnr order".

show me the posts saying 'everyone should be given cpr even if they don't want it."


The complaint is about the fact that this facility and this corporation, as a matter of policy, refuses CPR to EVERYONE in their independent living facility, whether they have a dnr order or not.

[pinboy3niner]

129. In this case the daughter confirmed that her mother did not have a DNR order

And the CBS News affiliate in L.A. just gave this update:

The nurse from the 911 call is now on voluntary leave; and the facility now says that the nurse did not understand their policies.

[HiPointDem]

130. IN THIS CASE. The facility is lying when it says the nurse did not understand their policies

Last edited Wed Mar 6, 2013, 05:38 AM - Edit history (2)

as multiple spokespersons had already defended the nurse and the policy in the media and in writing, e.g.:

In a written statement, Jeffrey Toomer, the executive director of Glenwood Gardens in Bakersfield, Calif., says it is the facility's practice "to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives. ... That is the protocol we followed."

Toomer offered condolences to the woman's family and said a thorough internal review would be conducted. He told KGET-TV that residents of the facility are informed of the policy and agree to it when they move in. He said the policy does not apply at the adjacent assisted living and skilled nursing facilities.

http://www.huffingtonpost.com/2013/03/04/nursing-home-cpr-case_n_2804575.html

Do you think the executive director of this particular facility *also* "didn't understand the policy"?

The facility is owned by a company called Brookdale Senior Living, which has facilities in 36 states, including 12 in Washington. Many of those facilities -- including one in Lynnwood -- are under the Clare Bridge brand.

Nurses at the Lynnwood facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.

http://www.komonews.com/news/local/Assisted-living-nurses-not-required-to-give-CPR-to-dying-residents-195180431.html

The nurse was carrying out the corporation's policy and is being made the scapegoat. But now the big corporate honchos are pretending they don't have such a policy because the policy is clearly DISGUSTING and INHUMANE. And because they're getting hammered for it:

Glenwood Gardens' parent company, Brookdale Senior Living, has a Facebook page that is filled with comments. One calls it a "death facility." Another says, "If you fall over, they are not going to do CPR." And, some claim their comments were deleted.

On Yelp, there are similar sentiments. People from all over the country, again and again, are giving Bakersfield's Glenwood Gardens a one-star rating. One person commented, they wished they could rate lower. Another commented on Yelp saying, "It's where Heaven is just a phone call away." It seems to be the start of a public relations nightmare, as former prosecutor and legal commentator, Star Jones put it on "Today," that possibly might not have been avoided.

http://www.kget.com/news/local/story/Glenwood-Gardens-in-the-national-spotlight/uxvuCpj170y6xQDz0bsNQQ.cspx

And this corporation is the LARGEST OF ITS TYPE IN THE COUNTRY.

Glenwood Gardens is owned by Brookdale Senior Living, based in Tennessee. It is the nation's largest owner and operator of senior living communities, with more than 645 facilities.

http://www.kget.com/news/local/story/Glenwood-Gardens-in-the-national-spotlight/uxvuCpj170y6xQDz0bsNQQ.cspx

Furthermore, you have not supported the claim that there are a lot of people on this thread who don't like 'choice'. (though on edit it wasn't *your* claim)

additionally, the emts that arrived DID CPR, so apparently the facility didn't even know the woman's dnr status at the time, because the emt's WOULDN'T HAVE DONE THAT if they'd known she was DNR.

Bayless did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.

http://www.huffingtonpost.com/2013/03/04/nursing-home-cpr-case_n_2804575.html

so the OPs 'concerns' about broken ribs are also beside the point, because if you call 911 and you don't have a DNR THEY'RE GOING TO DO CPR.

So this facility's policy only means that the person has MORE CHANCE OF DYING after being given cpr BECAUSE THEY DIDN'T GET IT WHEN IT HAD MORE CHANCE OF SAVING THEIR LIFE.

I can't believe people are DEFENDING this CRAP. "Oh, those old people, they're going to die anyway, they're so old and frail so don't treat them."

[LisaL]

198. If that's what they want, why should CPR be forced on them?

[HiPointDem]

199. where do you see me saying anything like that?

[GaYellowDawg]

137. Um, no.

It calls into question the wisdom of doing CPR on "frail, elderly" people at all. The feeling in this thread seems to be, "they're old. Why bother?" Not "don't do CPR to those who don't want it." It sure as hell is an anti-CPR thread.

And the way to not get CPR done is to put it in advance directives.

[pnwmom]

85. What???? It's an everybody-needs-to-make-their-own-decision thread.

Ahead of time, before a crisis occurs.

CPR isn't a one size fits all solution for everyone.

[MineralMan]

70. If CPR does not succeed broken ribs do not matter.

If it does succeed a life is saved. The person in cardiac arrest is in no position to tell you what he or she wants. I will opt to perform CPR. Saving one in five is worth my time, I think. If you prefer not to do it, please move out of the way. Thanks.

[LisaL]

79. Her family says she didn't want intervention.

Why force CPR on an elderly woman who didn't want it?

[Hekate]

95. If they'd done that to MY mother after she'd said not to, she'd have sued them blind afterward

(Rest in peace, Mom. I'm glad you got to go the way you wanted to.)

[MineralMan]

152. I was not there, nor do I know that woman's wishes.

I'm only talking about what I will do if I encounter that situation and have no information regarding the person's wishes in the matter. I'm trained in CPR, both the old method and today's chest compression only method. I will use it if the situation comes up and I do not know how the person who is down feels about it. That I promise.

You can do as you please, obviously.

[pnwmom]

88. The person in cardiac arrest was in a position to say what she wanted

when she made the choice to live in the independent living facility.

My mother in law made that choice because it was much more important to her to live independently than to extend her life through medical care. And the meals they gave her, and the bus rides, kept her going till she was 95 and got cancer.

[MineralMan]

151. But did she do that? I don't know.

I'm only talking about my own response should I encounter someone in cardiac arrest. If I don't know their wishes, which is the most likely situation, I will begin CPR on that person. You can do whatever you wish, of course.

I know my mother's and father's wishes in the matter. At age 88, neither wants such action taken on them. If I know someone's wishes, I will act accordingly. However, it's far more likely that I would encounter someone down and in cardiac arrest in a situation where I do not know their wishes. In that case, I will begin CPR and continue it until professional help arrives.

I'm 67 years old. At this point in my life, I want someone to do that for me, should I be in cardiac arrest. I may change my mind later in my life. I don't know. I'll deal with that when I need to. However, I would still want someone who does not know my wishes to apply CPR if they find me down and in cardiac arrest.

Again, you may do as you wish, but please do not try to stop my efforts unless you personally know the wishes of the person. You will not succeed.

[pnwmom]

185. Her family said on Tuesday she was fully aware of the policies of the independent living facility

and that she wanted to die a natural death. So they're not going to be suing.

People our ages and older all remember several cases of people being hooked up long term to tubes and receiving medical care to keep them alive, despite having no quality of life. The very old people I've known are all terrified of that possibility. They're happy to remain alive as long as they can, but they don't want to be tortured at the end, or to be kept alive even though they're unresponsive.

[Silver Swan]

92. I remember reading a very touching essay about CPR in a nursing journal many years ago.

The main point was that CPR is often does as comfort for the survivors. It gives time to say goodbye.

[HiPointDem]

142. no, it's not done to 'comfort' the survivors.

[kickysnana]

96. The system makes it impossible for anyone to know the truth

You have your doctor, a hospitalist and then are usually sent to a rehab facility to another doctor. Nobody sends message back to the previous doctor.

I argued with a colleague of my Mom's primary care physician that she was not strong enough to be moved to a transitional facility with documented reason. I pulled together a family conference in 2 hours because I was so sure. I was told I was wrong. We had been told that she would probably survive another 5 years with her COPD based on the tests they took she collapsed. She died three days later. Her primary care doctor never knew. I complained to the hospital, then they gave me a paper on how to protest premature release from the hospital. Not the day I spent all morning trying to save Mom.

She had many, many things planned when she got home and she was looking forward to the birth of a second great-grandchild. So no, It was not better that way. She was alert and alive yet until this crisis. Everyone had exhaled after talking to the doctor that morning, I was the only one who knew that they were wrong and it still was a shock when it happened. I cannot imagine what it was for my siblings who believed that doctor.

[Apophis]

125. 20% is better than 0%.

[Violet_Crumble]

133. Thanks, but for serious advice like this, I'll trust my own doctor...

And if they don't have the same opinion as you then guess whose advice I'll trust...

[GaYellowDawg]

135. Well, what the fuck?

Do you just sit by and let someone die? "Hey, there's less than a 20% chance of living. Why bother? So long, and try not to crap your pants when you go."

My grandmother, at 83, fell down a flight of stairs, bounced, and landed on a vacuum cleaner. Broke several ribs and separated her shoulder. Probably comparable to any damage she could have sustained from CPR. You know what she did after getting out of the hospital? Physical therapy, that's what she did, and she lived 4 more years in better health than the 4 prior to the fall - and would have lived longer, if she hadn't gotten caught in a house fire. She was tough. Oh yeah, and did I mention that she'd had a heart attack at age 81?

In my opinion, anyone who asks the question, "Should a frail, elderly person receive CPR?" should receive the answer "If they want it, yes, and quit being such a fucking turd, and start fucking compressing, asshole." Age is not a sufficient reason to deny treatment. There's plenty of reason if you're one of those doctors whose main concern is whether or not treatment will result in a lawsuit. Or if you're an insurance company, and you'd rather just have the old bird knock off instead of paying for extended care. Well, fuck both those categories of people.

Holy shit. Talk about ageism. Hey, they're old, why fucking bother. Why don't you just turn all the "frail, elderly" people out into the cold? Surely all the trouble of heating their domiciles isn't worth the trouble.

[HiPointDem]

140. +100.

[MADem]

145. +1 nt

[datasuspect]

158. turn off the lights

thread over.

WIN

[LisaL]

196. This woman wanted to die naturally.

So she didn't want CPR done on her.

[HiPointDem]

204. But she *had it* done on her, by the EMTs. So apparently this facility didn't bother to tell them

about her wishes. Or perhaps they were too disorganized to know *what* her wishes were at the time. Or perhaps her wishes were irrelevant as the facility had a blanket policy of not doing CPR regardless of anyone's wishes.

If she had a DNR order on file, why would they call 911 and allow the EMTs to do CPR on her?

How come in the early reports the emergency personnel said she had no order on file? I doubt they would have said that unless the facility *didn't tell them* she was DNR.

Bayless did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.

http://www.huffingtonpost.com/2013/03/04/nursing-home-cpr-case_n_2804575.html

Questions, questions.

She didn't get what she supposedly wanted, in any event.

[DeschutesRiver]

157. Coincidentally, I just listened to a podcast covering the same thing

It specifically mentioned that in tv shows, 75% of the time CPR is shown as having been a success. Which leads people to believe that not giving CPR is just crazy. However, in real life, it is only around 8% successful, and of that percentage, only around 3% are lucky enough to resume their old lives just as they were - another 3% go vegetative, and the remaining end up dying (iirc). The odds were so horrifically low that I still am going to try to verify them to be certain (I'm on dialup, so it takes time! But your post seems to track with the podcast). I've put a link below, as you will probably find it interesting (you can listen to the podcast, and there are comments on the website worth considering as well).

All of the older doctors interviewed had either DNRs, or health directives, or a necklace or even tattos stating their wishes with regard to not doing tons of intervention should something happen to them, given what they'd seen as to the outcomes of some of these procedures esp in regards to older people.

I too, like many on this thread, had initially wondered why the heck the facility didn't do CPR. I then by happenstance listened to that podcast as it was next in line, and then gave the whole issue a ton more thought and reflection (and thanks for your link as well).

And realized that if I had chosen, in my old age, to live in a center specifically because it wouldn't do things like CPR, etc, but just call 911 instead, that I'd be suing them sideways if they'd revived me when I'd given instructions not to do so, and even chosen to live in a venue where it would not be done to me.

I am a bit flummoxed that some people would not let me have choices with regard to how I die, esp. on a progressive board where choices regarding how one lives are sacrosanct. As both should be. Yes, I get that we shouldn't just not do CPR because people are old, and just baggage to be disposed of; however, that doesn't seem to be the case here. You can't just say well, since it is possible that SOME people might just let oldsters die because they are useful, then we won't let ANY oldster go without CPR, even if that was their wish. I understand that there can be instances where the person's wishes cannot be known - whole different can of worms there. But given where this woman lived, this doesn't appear to be one of those instances.

So unless I've misread it, this isn't a case of not doing CPR only because the woman was old. Do people honestly believe I have no say in the matter and that my wishes with regard to death should be disregarded simply because I am old now? If I choose to live at a facility that will not perform CPR and is only allowed to call 911 in an emergency, is that not enough protection for my wishes in this regard? I'd have guessed it should have been clear because I live in such a place that these are my wishes too, but maybe some think that once we get older, that if we wish to chose our way to pass without much intervention, we must have lost our minds. Which just isn't fucking true.

I can see why doctors are going to the extreme of tattoing their decisions to be perfectly clear in such cases. When I get to be of a certain age, I will do so as well, rather than just depend upon a written document that others will disregard because of the nature of the emergency moment.

http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/

[pnwmom]

194. Thanks for your link and post, DR.

I think some of the very negative posts are from people who've just never had much experience with these issues.

You might be interested in hearing more on the family's statement. Here it is:

http://www.democraticunderground.com/10022470041

[DeschutesRiver]

208. Thanks for that link as well re family statement. Although these threads have Terry Schiavo aspects

- though in that old case it was the religious right (who bleats for a small government that stays out of their personal business) who spent their every waking hour shrilling that they knew best how this vegatative woman's business should be done, and that was that she be kept alive. Period, because that is what they wanted for themselves, so same for her. No matter what her family said about it. It appears on this thread that some do not care what the deceased thought, nor those who knew her best, either. The posters weren't there, but they know better! They know how ALL these situations go! Which might be comforting to think so, but it isn't actually so, no matter how much we wish it were so. I don't know if having experiences with these kind of issues would result in a different kind of behavior - some people just can't believe that other people might have actual different opinions on these life/death matters, and because of that perspective, often rush to judgment rather than seeking all available facts first.

I have seen some posts where it is possible those posters might have a different take once they speak from place of reality, and not just from theory. But I am really glad you posted what you did, and that there is a discussion of this issue taking place - because not a one of us gets to actually escape death, and it may provoke reflection that is a bit deeper regarding how each of us wishes to handle the inevitable event.

The only good news for me is that not only can a person fill out a general health directive or DNR, but because I live in Oregon there are limited situations in which I can make a choice for myself if I have a terminal illness - I am more used to that idea angering conservatives, rather than progressives. But in either case, I can do as I wish which is what matters to me. Regardless of whether it is the same choice another human would make or not.

And better - I also have a wide range of people I know and if one is determined, no, not even the most staunch "you can't decide this for yourself" advocate, whether on the right or left, can stop a me from making this choice for myself. That is true for anyone, if they are realistic about it and plan for things. That said, no one should have to put such "plan b's" for uncertain circumstances in place behind curtains or in back alleys. But it should be out in the open, though I doubt it will happen here in America in my lifetime.

[pnwmom]

209. In WA state we copied that law of yours and so that's an option here, too.

My dying mother in law was begging for it, because her pain wasn't being managed properly. We couldn't find doctors willing to sign off but it turned out to be a moot point -- once we got her pain under control she stopped asking, and passed (from cancer) pretty quickly.

[DeschutesRiver]

211. I did not know that WA had done the same

That is good news - it never hurts to have every option available just in case they are needed. I am really sorry that your MIL experienced what she did but thankful that her pain became managed and that the end was not prolonged. And am so sorry for your loss - cancer simply sucks.

It wasn't until experiences later in life that I came to understand that pain management is a big deal. I used to focus entirely on things like avoiding potential addiction, over-stressing an injury, or not wanting to use a pain med until absolutely necessary (side effects, etc). But of course, that was because I was younger and hadn't seen/understood the pain resulting from a terminal illness, nor really contemplated what pain is and why managing it is far better in a lot of cases than just trying to avoid it until things were unbearable.

It was one of those "when you know better, you do better" kind of epiphany moments, and now I definitely approach all pain situations from a new angle.

[JVS]

171. If I'm dead, I won't care about cracked ribs. Go for it!

[pnwmom]

192. If you're 87 and it only gives you a couple more weeks of life, you might regret it.

[HiPointDem]

202. and you might not.

[w4rma]

178. Hell yes. I'll take a 1 in 5 chance over no chance, anytime and anywhere. (nt)

[pnwmom]

191. Me, too. But I won't want it when I'm 87. n/t

[hughee99]

190. After years of TV watching (where it almost always seems to work),

I'll admit I'm surprised by the number, but if CPR doesn't succeed, are the broken ribs really a big issue?

[pnwmom]

193. They're only an issue if you would rather have a relatively peaceful death than a violent one. n/t

[HiPointDem]

200. hogwash. there is no guarantee of a peaceful death.

[dkf]

206. People need to realize that if you are frail, CPR is very painful.

And the odds of a recovery to your baseline are slim

The problem is most people have no idea of the downside and then make uninformed decisions.

This does need to be an persons choice but it should also be done with a lot more awareness of how bad it could be. A heart attack seems one of the more merciful ways to go.

[Javaman]

212. Even less than that...

I just got "recert'd" about a month ago and the stats the fireman was giving us almost leads one to not even bother.

But we are human and still feel the need to do something.