From a DNR Order to a DNH Order

The idea of having some say over how or when we die has resulted in the development of action plans like Advance Health Care Directives (AHCD) that inform what an Enduring Guardian requests of the medical staff attending to a loved one who can’t speak for themselves.  It covers a range of issues including Do Not Resuscitate (DNR) and Do Not Intubate (DNI).

Taking this idea to the next level and taking into account that: “Eighty percent of terminally ill patients say they want to avoid hospitalisation and intensive care at the end of their lives” it makes you wonder why so many people in reality end up getting something other than their preferred choice.

Ann Brenoff writing in the Huffington Post (Want Control Over Your Death? Consider A ‘Do Not Hospitalise’ Order, 14.07.2017) reports that “hospital stays nevertheless occur – even though they don’t make much difference.”

“Studies have shown that people who received less intense care in the last six months of life did not have a higher mortality rate than people who received more intense care.”

So with all the stress and uncertainty that comes with medical tests and painful intervention as a consequence of hospitalisation, why do so many “wind up blemishing their final days” languishing in a hospital bed hooked up to machines?

Because we can and because we can pass on the cost to the public health system or a health fund. That reads as a statement but that sentence could well start with ‘Is it’ and become a question that we might ponder.  These are  the kinds of questions that exercise the minds of those of us who attend Die-alogue Café discussions.

“Family caregivers sometimes mistakenly think ‘do not hospitalise’ means ‘do not treat’.  But that’s not the case. A DNH order can stipulate that under specific circumstances, like you are bleeding or in extreme pain, you do want to be treated in a hospital.”

AHCD have been encouraged for years and yet most people have not completed one let alone had the conversation with themselves – or family and friends – about their preferences come those ending of days.

Whatever we think, we need to speak about with others.  Whatever we hope for, we need to write down and bring others into the picture.  The goal in all situations is best achieved when it honours people’s wishes and it provides loving care that is appropriate and minimises suffering.  The more choices the better.  The more we talk the more enlightened the conversation will be.

To read the full story:

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