Do Not Even Think About Trying To Resuscitate

A nurse at an assisted-living facility in California followed her employer’s rules last week and stood by as an 87-year-old woman lay dying. A 911 dispatcher urged the nurse to help the woman anyway. According to station KCAL in Los Angeles (a CBS affiliate), the dispatcher asked the nurse who had made the call, “Are we just going to wait and let this lady die?” The nurse replied, “Well, that’s why we’re calling 911.”

I would like to shake that dispatcher’s hand. End-of-life care is a challenge; there was a policy at the facility in question not to perform CPR; the deceased woman, unnamed in the KCAL story, may have had a Do Not Resuscitate (DNR) order through her own choice. Even so, how can we not cheer for someone whose gut-level reaction to a moment of crisis is to care, not to abandon?

A question has been nagging at me after learning of this woman’s death: how far are we from DNR being everyone’s default medical order? More questions arise. If a facility’s DNR policy is appropriate for an 87-year-old, how about someone who’s 85? or 65? Someone has to decide if there’s a cut-off age. No-CPR was the facility’s policy. The news carries no word on whether the deceased woman voluntarily signed a DNR, or if signing one was a requirement for admission to “assisted living.” Assisted? Really?

I heard about this story briefly on NECN this morning, and I went online to find more information. There are blog posts a-plenty, but it took me some time to find the hard news story. CBS Los Angeles has already moved on to other things, with this story no longer on the home page of the web site as of this morning, although it’s available via the link above.

I was with both my parents in their dying days. My father died in a hospital, from cancer.  My mother died in hospice after two weeks in a hospital, after a fall and fracture that led to multiple organ failure. Their wishes for no CPR were clear and, in accordance with our Catholicism, absolutely appropriate. Their wishes were not dictated by a medical facility. There was therefore no hint of denial of care. I am under no mandate, religious or otherwise, to seek physical immortality for myself or for anyone else. That’s the stuff of horror stories.

Even so, I’m haunted by what we don’t know about that woman in California, who died in the hospital after being transported from the “assisted living” facility. Where was she when her heart stopped?  If the facility has a DNR policy on all residents, why even call 911? Was she dead on arrival at the hospital, or did she die sometime later?

CBS Los Angeles’ news story quoted both an attorney and a physician who were appalled by the action, or inaction, of the nurse on the scene and by the facility’s policy. The woman’s family apparently has no issue with the policy, so litigation is unlikely. Ethicists will argue about this case, and that’s about it.

Perhaps this goes on at facilities all over the country, and most 911 operators find such calls unremarkable. We are all the poorer if that’s the case. If a facility makes the decision about denial of care, that is a far cry from the patient autonomy that used to drive public policy debates about end-of-life care.

2 thoughts on “Do Not Even Think About Trying To Resuscitate

  1. I can help correct some of your facts, Eileen, though you may have learned more from the updates since you posted this. There were a number of mistakes in initial news reports.

    1.) It wasn’t an Assisted Living facility. It was an Independent Living community, basically apartments for seniors with concierge amenities, but no resident medical staff. The 911 caller merely happened to be a nurse. Her job was Resident Services.
    2.) There was no DNR on file, but according to the surviving daughter the facility acted according to the woman’s preference for no heroic measures to be taken. The patient’s wishes should ALWAYS come first.
    3.) Though the 911 caller qualifies the condition as “barely”, the woman was breathing. The 911 dispatcher therefore clearly overreacted and gave improper instruction. What was medically needed was oxygen (for comfort) and probably an AED, to restart/regulate the heart. CPR would have been ineffective, and considering her age she could have been injured in the attempt.

    Depending on your statistical source, the chances of an 87 year-old returning to full health after a myocardial infarction are 3-5%, no matter what actions are taken. I question the morality of bankrupting your surviving loved ones for three months of non-responsive “life” in an ICU. I think it’s time people began viewing death as a natural thing, not something to be always fought against. Our concentration should be on providing comfort whenever possible during the process of dying.

    1. Thank you for the updates. You and I agree about patient wishes and about viewing death as a natural occurrence. My experience with my own parents in their last days underscores your observation about how CPR can be not just ineffective but inappropriate. I am however concerned about the apparent one-size-fits-all policy at the facility. Thanks for reading.

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