For those who don't do this regularly or have had to deal with it, DNR/DNI stands for "do not resuscitate/do not intubate." They are some of the primary issues of treatment addressed in advance directives.
People had been telling me I should watch the TV show "HOUSE." They said it was well written and the medicine is good.
So tonight I tried to watch it. The whole thing was about a guy with an unknown paralysis and House (the main character) decides to intubate the guy against his "directives."
The whole show essentially represented the entire issue of DNR/DNI incorrectly and as shown in the episode would make anyone terrified to ever sign a DNR order.
Despite the feel-good ending, I felt like I was watching evil propaganda.
Let's understand a few things about advance directives. Advance directives are made in case you are in a condition where you can't represent your wishes AND there is no reasonable expectation that your situation will improve so you can represent your wishes. That is the key here. These are situations like in progressive dementias like alzheimer's, Pick's vascular dementia etc.. (and this applies to people with these illnesses only when they have progressed to the point where they can no longer represent their wishes.) It also apples to people with brain damage, stage four cancer who are delirious or in a coma. The idea is, you have a basic underlying condition that wont improve and if in the course of that illnesses' progress you are prevented from communicating your wishes you have stated in advance that you don't want to be treated for say, pneumonia as you know you are dying of this process anyway then that is your wish. Where it gets complicated is with heart patients who very often are alert and organized enough to restate their advance directives in the present (usually this is about intubation) and often they have to go through seeing the psychiatrist to make sure the patient isn't suicidal before the directions are followed. Ultimately, for many, the DNI part is way more important than the DNR part but that is beyond the scope of this diary.
A person with advanced directives who chokes on a peanut isn't denied a chricothyrotomy because he has said he doesn't want to be intubated. That is ridiculous. The person is expected to recover from the peanut briefly blocking his airway. However, if a person chokes on a peanut, passes out and his brain is deprived of oxygen for 6 minutes (I'm splitting the difference on purpose) then the advance directives kick in because there is no reasonable chance he will recover.
Also, for what it's worth, a person who is DNR/DNI can have surgery, with general anesthesia - where they will obviously be intubated. It doesn't neutralize the advance directive because there is an expectation the person will recover.
Above everything, all decisions are up to the patient as long as he/she can make decisions - so everyone is free to change their mind ALL the time.
We all go through basic periods when we are briefly unable to make decisions for ourselves - if we're drunk, have a fever - whatever. The point is if we choked during one of those times and had advance directives it doesn't mean we couldn't be saved because not only will we survive the peanut but we will survive the hangover or flu - probably.
Subtly, many have come to fear advance directives along with organ donation and there have been tons of creepy shows about the misuse of both. I'm not going to write about organ donation right now but these misunderstandings about advance directives create more human misery for both the patients and their families than anything I know of. This fear also costs the health care industry billions.
We could all live without these creepy bits of propaganda.
The medical advisors on the show know everything I'm saying from their own experience.
So who is letting this happen?