by Claudia Windal

Created on: August 20, 2008

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

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