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Tuesday, December 14, 2004 CE

DNR vs Full code

As a doctor I have seen many times terminally ill patients decide between them. For the people who is not familiar with those terms, DNR means Do Not Resucitate and Full Code means that a full ACLS (Advanced Cardiac Life Support) protocol has to be started in the event of cardiorrespiratory arrest. It is a complex topic because it involves the patient's beliefs, his or her idea of his or her own death and the interaction with the family. As doctors, we cannot decide for a patient, however, we have to provide honest information with respect to overall prognosis and likelihood of brain functionality after a "code". Furthermore, we can advise the patient what is best for them. The final decision is made by the patient or the family.

One of the most rewarding experiences as a physician is to see that the terminally ill patient has understood the process of his or her terminal disease, has grasped the concept of irreversibility and has opted to be a DNR. It means that there has been a healthy and open communication with the health care providers and it ensures a peaceful death. On the other hand, one of the most difficult scenarios for a doctor is the case of a terminally ill patient who, in an attempt to remain attached to life, requests that "everything has to be done to remain alive". This usually means poor patient-physician relationships in the past associated to deep distrust in the health system. Many times the result of this is a violent death during an ACLS protocol or an artificially prolongued life in an intensive care unit.

My point is...if you are a doctor, talk with your patients, be honest and give sincere advise. If you are the patient, or the family, please ask for information and try to avoid the conflicts that lead to suffering and prolongued misery.


Blogger Puma said...

How do you feel about doctor-assisted suicide, or Death with Dignity as it is sometimes called?

10:36 AM  
Blogger Doctor Marco said...

First, an opinion is a very personal thing, we doctors have the duty to behave according to the rules and laws of the societies where we work.

In my opinion, assisted suicide should be an option for the terminally ill. The patient should have a full psychiatric exam to rule out mood disorders and psychotic disorders. This is to ensure that his decision is totally voluntary and not due to a disorder that alters the process of thought. Pain should be under control or at least minimized. At least 2 senior staff physicians should agree with the patient, ideally the primary care provider and the subspecialist in charge of the illness. A lawyer should be there, but just to certify the agreement, like a notary. Lawyers should clearly not be involved in the decision making process because they will always say "no".

In many circumstances things that can be compared to this situation are actually done, like patients that actively decide not to continue with hemodialysis. This is very close to active euthanasia and happens every now and then. Nobody makes a big deal of it because in all cases everyone agrees.

Two things:

I have added a forum link in my site, so if we decide to have a longer conversation about something, or if we want to talk about something not related to our postings we can go over there, if it is ok with you. It will make debates/conversations easier to find.

Apparently nobody has read my post named "Prisoners". I am interested in your opinion.

If you know people that would appreciate my blog, I have a "Tell a friend link" try it and see if you like it

Bye for now

7:16 PM  
Blogger Gindy said...

As someone who's family has been through this situation, I appreciate your post about telling all of the facts. Depressing topic Great post. Just because many people will eventually have to deal with it one way or the other. By the way. I am going to throw a link on my sight.

8:54 PM  
Blogger Doctor Marco said...

Gindy, thanks. If you see my blog, now you have a link there.

11:28 PM  
Blogger aphrodite said...

One of the most inhumane events that I have witnessed, is when a patient is incoherent, suffering, severely mutilated, brain-dead, or has a very extensive list of critical diagnosis and the DPOA (durable power of attorney)decides to prolong that person's life for the family's own sentimental reasons. It is important to have your own wishes on a legal document prior to a resuscitative event. When the prognosis is poor allowing a loved one to freely die, in my opinion, is humane. Like my daddy always says "if you see my in that condition, give me a gun. If I can't pull the trigger....well, just shoot me then!"

9:18 AM  

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