Is signing a DNR (do not resuscitate) order passive suicide?

No

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by Claudia Windal

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Imagine being an 89 year old woman brought by ambulance to an emergency room because your heart rate is only 40. Paramedics have made four attempts to start an IV without success, you are hooked up to a heart monitor and are receiving oxygen. The move from the bed to the ambulance cot is miserable because of your severe arthritis and the trip frightens you simply because you have been confused for years and many days you don't even know where you live.

Once in the emergency room, a determined nurse is able to start an IV. Your heart rate has dropped to 30 and is irregular causing the physician to order an EKG and several medications. While the medications are dripping into your vein, your heartbeat suddenly drops to 10 and is irregular. The team begins CPR in an attempt to circulate enough blood through your brain to keep you from becoming brain dead while your life is "saved."

Two hours later, you are moved to the cardiac care unit (CCU) where CPR needs to be initiated again because your heart rate has slowed and your respirations are irregular. One of the doctors calls out to a nurse, "call the family and see if we should keep this up; tell them she's already a 'vegetable'."

Who among you readers would opt for a scene like this with your parents or even yourselves? The DNR order permits us to die naturally and without all of the invasive and painful procedures I have described.

The DNR order generally specifies no resuscitation if it is likely that the individual would not be able to live without a respirator and/or may never regain consciousness, and/or that the brain may never recover from lack of oxygen. This wording allows individuals to recognize that they may be resuscitated (heart started and breathing) but that they would simply be artificially "living." They may love life to the fullest, and yet, if that life is nothing more than "being" in a hospital, artificially fed and oxyenginated, and unaware of the world around her/him then they would rather die naturally.

Not so many years ago, doctors were hesitant to follow DNR orders because they feared liability or because their own religious traditions did not support such decisions. I worked with people who had been diagnosed with AIDS. A close friend and client was admitted to the hospital for the tenth time in four months. I asked him if he was interested in completing a living will. John had told me multiple times that he did not want to be resuscitated. We worked on his living will together and John stipulated that he did not want to be resuscitated. I brought the desire to not be recoated to the attention of nurses and his physician and the doctor said he would write the DNR order. Later in the day, John began having seizures and I remained with him through the night. At one time, I asked a nurse to check whether or not the DNR order was written. It was not! I remained through the night, as John continued with seizures and 102 fever. I kept the chart with me. When the physicians came to make rounds they demanded the chart. I would not relinquish it until they had written the DNR order and fulfilled John's wishes. I though the security guard was going to have me arrested, but I was determined to have John's wishes honored. This is a man who would not have easily given up his life. He was filled with talent, was close to the Creator, and might have had a long life ahead of him had he not contracted HIV.

Today, doctors, chaplains, nurses, social workers, and others in hospitals talk with those who desire an order to not resuscitate and they assist them in writing the specifics of their desires (the circumstances when the DNR would be initiated). Allowing the natural process of death to occur is foreign to many medical professionals, and few of us truly want to die.

In the worse case scenario someone who has some suicidal ideation may indeed initiate an order to not resuscitate. Those who work with people who are planning for end of life, are generally astute to the many reasons one might want a DNR order and may gently guide someone they believed to be suicidal to professional help.

We can't second guess everyone and we are obligated to honor the desires of one another.

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