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Living Wills: Part 4 – Continue resuscitative measures?

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Living Wills: Part 4 – Continue resuscitative measures?

Once you have considered all the options and determined whether and when to remove life support and artificial nutrition and hydration, you then have to consider whether to allow the doctors to continue providing certain resuscitative measures such as CPR, mechanical respiration and/or antibiotics. 

This section of the Living Will is what I call a DNR component (“do not resuscitate”) of the Living Will, but it is not a true DNR.  The question on the Living Will specifically states, “if I am in the condition(s) described above [i.e. in a “Persistent Vegetative State” or “Terminal Condition”], I feel especially strongly about the following forms of treatment”.  A true DNR, on the other hand, is a direction NOT to resuscitated under ANY circumstances.  The DNR component of a Living Will, however, applies only if your heart stops, you stop breathing or you develop an infection after you are on life support and two doctors have determined you are in a “Persistent Vegetative State” or “Terminal Condition”.

To put the question in context, then, I always ask my clients:

If you are incapacitated, you are on life support, two doctors have certified you are in one of those two conditions, and you are in the window of time you selected (i.e. if you chose 7 days to be on life support, if you are in that 7 day window), and your body starts shutting down, in spite of being on life support, do you want the doctors to continue providing these resuscitative measures – CPR, if your heart stops; mechanical respiration if you stop breathing; or antibiotics if you develop an infection?

The answers vary, quite frankly.  As far as CPR and mechanical respiration, some people want to make sure they are given every opportunity to survive and recover, so they opt to allow their doctors to provide these resuscitative measures during the time they are on life support.  Others recognize the futility as well as pain and suffering for themselves and their family in continuing to be resuscitated potentially multiple times over.  For them, the choice is obvious that they do not want these resuscitative measures. 

As far as allowing antibiotics, most people understand and believe the administration of antibiotics is not as brutal or intrusive as CPR and/or mechanical respiration, nor do they see antibiotics as necessarily harmful in those circumstances.  Rather, most people, so long as they have allowed for sufficient time on life support for antibiotics to be fully effective (i.e. 7 days or more), allow the administration of antibiotics in the event they develop an infection. 

As far as CPR and mechanical respiration, the main thing to be aware of is the fact that these resuscitative measures, especially CPR, are brutal on a person’s body and often result in ribs being broken because the chest compressions have to be very hard to be effective.  Real life CPR and mechanical respiration are nothing like TV or movie portrayals.  In real life, even the staunchest supporters of resuscitation will waiver while they are watching it happen.  The main thing to understand doctors and/or nurses, if your heart stops or you stop breathing, are required by law to continue CPR and/or mechanical respirations unless/until you pass or until you recover a heartbeat/breathing, which can be very difficult for your family to witness.   

As always, the right choice is up to you, and the best choice is what is best for you and your family who will be with you in these moments.