DNR does not equal suicide

I don't know why this is, but over the last several months I've encountered more families voicing some suspicion about hospice care than I did previously. Perhaps the elevated level of attention to health care (death panels, anyone???) has made people more comfortable asking questions than before; that would be good. Or, perhaps the elevated level of attention given to health care has made people more suspicious of the intentions of health care professionals (that might be good or not, depending on the situation).

A couple of people have asked me, as the chaplain, whether or not a DNR (do not resuscitate) order is tantamount to suicide. This is an interesting question, and it may be that in some communities there are recommendations against the DNR--I don't know. But in the cases where I've been asked, I've been familiar enough with the faith tradition to be able to assure the person that a DNR is not considered equivalent to suicide. I think there is a misconception about resuscitation, perhaps based on TV, where rescues are so often so totally and unconsequentially successful. To be sure, sometimes resuscitation does succeed, but if you or your loved one is older and frail, and there's a terminal diagnosis, especially one involving the heart, the chances are that if your heart stops, it won't be in the mood to start up again no matter what is done. Without the DNR, the default position of a first responder has to be to try to bring you back, and that will involve someone slamming her or his weight on your chest about 100 times a minute. If your heart SHOULD be horrified enough to start up again, and you SHOULD eventually wake up, consider that now you will have the terminal diagnosis you started out with plus multiple rib fractures. This will not feel good. You won't be able to breathe well enough to keep your lungs clear, assuming they were clear to start with, and you will have won the battle but lost the war, in a painful way. Having the DNR in place is not suicide in this situation. Rather, it is protecting yourself or your loved one from what is called "futile care" -- that is, care that won't help you. Although, as I say, it may be that some religious communities have a particular opinion about the DNR, I'm not aware of any that believe we are morally obligated to accept care that won't help us.

That said, there are some people who need assurance from their own community or denomination when it comes to the implications of treatment decisions. They can't and shouldn't rely on my word as a chaplain. That's when my job is to facilitate the conversation where it needs to happen, and stand with the patient or family member against pressure for a fast decision. It's easy for the medical system's value for speed to take over, but at the same time a patient or family member who is not sure about a decision is one who will carry that unsureness forward throughout the course of the decision, whatever that may be. Especially in a decision for comfort care or hospice, it's normal to have some lingering doubts, which can be very painful and stressful, but if a simple visit with a priest or pastor or leader can take some pressure off or offer some concrete guidance, it's well worth having that visit.

Someone once mentioned a desire to "have my DNR tattooed on my butt." If you have a similar intention, let me do my civic duty and warn you that the first responders will not roll you over to check your butt. Have the DNR, and the name of your MDPOA, tattooed on your chest, which is what they will pound on if they feel the need to resuscitate you.