A great article on discussing a DNR with patients.
von Guten - Discussing Do-Not-Resuscitate StatusHere are the main points:
1) Establish an appropriate setting for the discussion. Ensure comfort and privacy.
2) Ask the patient and family what they understand about their current health situation.
3) Find out what they expect will happen and how they want things to be if they are ill.
4) Discuss a DNR order, including context. Specifically use the word “die.”
Say: “If you should die despite all of our efforts, do you want us to use heroic measures to bring you back?”
OR “How do you want things to be when you die?”
Do Not Say: “Well, if your heart and lungs were to stop, would you want us to use shocks to start your heart and put you on a breathing machine?”
5) Respond to emotions sympathetically, which can be silently offering tissues.
6) Establish and implement the plan depending on your judgment and institution policies.
Two researchers at Albert Einstein College of Medicine of Yeshiva University have found that our 98.6° F (37° C) body temperature strikes a perfect balance: warm enough to ward off fungal infection but not so hot that we need to eat nonstop to maintain our metabolism.
The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon/journalist Atul Gawande in an essay entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”
A great article on discussing a DNR with patients.
