An uncle has categorically told us in writing that if he becomes unconscious, he is not to be resuscitated. This “do not resuscitate (DNR)” guidance is an example of an end-of-life (EOL) directive.
If my uncle were to really become comatose, I would still make sure he gets to an ICU and until the exact problem is known and has been diagnosed, I would find it impossible not to intervene. I have told him this in so many words, which has led to serious arguments…the one thing we do know is that when he is unconscious, he will not be able to question the decisions we make. If he recovers and is in good shape after the incident, then all arguments become moot, and if he doesn’t recover, then there is no argument anyway.
There are certain situations where an EOL directive may perhaps work. A person with end-stage cancer that has spread everywhere and has stopped responding to any form of medication, with all possible options including alternative ones exhausted, and is in pain, may elect to stop any further medical support, except for pain-killers and decide to spend the remainder of his/her life at home or in a hospice. This would be a decision that perhaps would be respected by all. But in more acute situations, when there may be a chance that the person might recover, these decisions become extremely difficult to make. In reality, even those who have decided to end their lives, find it difficult to go ahead when the time comes.
Recently a person I knew suffered a cardiac event, then started bleeding and eventually arrested a couple of times. He had given his family a DNR directive, but when the time came, no one had the guts to “not try” one last time. This extended his life by a few days and it was only in the end when it was obvious to everyone that nothing would bring him back that the decision was taken to let things take their natural course. The son was upset that he couldn’t abide by his father’s wishes, but it is difficult at that point in time to “do nothing”.
The issue is also of who takes the decision. If the sick person himself/herself decides to stop medication or perhaps stops eating and drinking, that is one thing. But if the decision has to be taken by the relatives and immediately family, when the patient is not in a position to talk or in a state of mind to be part of the decision making, then it becomes just that much more difficult.
I was discussing this with a friend of mine, who along with is brother, both doctors, had decided never to resuscitate their father who was ailing for a long time. In the end when an acute event occurred, neither had the guts to hold back and the father went on a ventilator to live for a few more months.
It is not easy! If family members elect not to follow DNR orders of their parent / relative, it does not mean that they are breaking a promise. Religious issues, family ties and personal courage all play an important role and to my mind, there is perhaps no right or wrong here! Judging these decisions from outside may actually be the only wrong!
In the end, it is all very well to have DNR and EOL directives…they sound great in theory, but are extremely difficult to implement in practice! And if you as a close relative can’t abide by them, so be it!