This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.guardian.co.uk/commentisfree/2013/mar/05/nurse-refuse-cpr-seniors-suffering

The article has changed 2 times. There is an RSS feed of changes available.

Version 0 Version 1
CPR more often prolongs seniors' suffering than saves lives CPR more often prolongs seniors' suffering than saves lives
(7 months later)
I seem to have misplaced my outrage.I seem to have misplaced my outrage.
In Bakersfield, California, an 87-year-old woman collapsed in a senior residence and was allowed to die by a nurse who was following company policy against staff performing cardiopulmonary resuscitation. In a recording of her seven-minute conversation with the 911 dispatcher, the nurse's affect was, to my ear, one of indifference.In Bakersfield, California, an 87-year-old woman collapsed in a senior residence and was allowed to die by a nurse who was following company policy against staff performing cardiopulmonary resuscitation. In a recording of her seven-minute conversation with the 911 dispatcher, the nurse's affect was, to my ear, one of indifference.
Not so the exasperated dispatcher who perceived, by phone, that a life-saving opportunity was passing and pleaded with the nurse to resuscitate the woman, or to get someone else to do it. But resuscitation was delayed until the ambulance arrived, and a short time later, at the hospital, the woman was declared dead.Not so the exasperated dispatcher who perceived, by phone, that a life-saving opportunity was passing and pleaded with the nurse to resuscitate the woman, or to get someone else to do it. But resuscitation was delayed until the ambulance arrived, and a short time later, at the hospital, the woman was declared dead.
Still, my outrage is missing.Still, my outrage is missing.
Oh, here it is. I found it in the story that wasn't covered – but which played out countless times on countless senior citizens that same day.Oh, here it is. I found it in the story that wasn't covered – but which played out countless times on countless senior citizens that same day.
In this story, CPR was dutifully performed, without regard for whether it might do more harm than good, followed by urgent races to the ER where holes were cut in throats to accommodate tubes, arteries were probed and accessed to provide antibiotics, fluids and perhaps opiates, and ventilators were cranked up to deliver to elderly humans what they no longer were capable of accessing on their own: the breath of life.In this story, CPR was dutifully performed, without regard for whether it might do more harm than good, followed by urgent races to the ER where holes were cut in throats to accommodate tubes, arteries were probed and accessed to provide antibiotics, fluids and perhaps opiates, and ventilators were cranked up to deliver to elderly humans what they no longer were capable of accessing on their own: the breath of life.
Except for a lucky few – roughly, one in five – these patients will not resume life as before. They will not eat for themselves, drink for themselves, clean themselves, or possibly ever feel another thing except maybe when their dressing is changed or feeding tube suctioned, when they'll grimace or moan. Maybe the heart will stop and CPR will be performed again. This will go on for days, weeks, maybe months.Except for a lucky few – roughly, one in five – these patients will not resume life as before. They will not eat for themselves, drink for themselves, clean themselves, or possibly ever feel another thing except maybe when their dressing is changed or feeding tube suctioned, when they'll grimace or moan. Maybe the heart will stop and CPR will be performed again. This will go on for days, weeks, maybe months.
Just another heroic episode of CPR at the end of life.Just another heroic episode of CPR at the end of life.
We want to die at home but increasingly, we die in hospitals. We want good deaths. We tell pollsters this all the time. But we seem to want only the good part, not the death part. We fear death. We fear everything about it – pain, grief, lawsuits, God's judgment. Our fear is systemic, undermining everything from dialogue between doctor and patient to a family's determination of what is best for a loved one existing in a terminal and interminable state in intensive care.We want to die at home but increasingly, we die in hospitals. We want good deaths. We tell pollsters this all the time. But we seem to want only the good part, not the death part. We fear death. We fear everything about it – pain, grief, lawsuits, God's judgment. Our fear is systemic, undermining everything from dialogue between doctor and patient to a family's determination of what is best for a loved one existing in a terminal and interminable state in intensive care.
I'm not sure what the Bakersfield nurse was thinking, though it must be a strange thing to be a nurse working for a company that restricts how you assist residents. And I'm not sure what truly was in the best interest of Lorraine Bayless, may she rest in peace. The news reports give no indication of the woman's medical state, whether she had completed an advance directive, or if she had stated her wishes for care in such a scenario.I'm not sure what the Bakersfield nurse was thinking, though it must be a strange thing to be a nurse working for a company that restricts how you assist residents. And I'm not sure what truly was in the best interest of Lorraine Bayless, may she rest in peace. The news reports give no indication of the woman's medical state, whether she had completed an advance directive, or if she had stated her wishes for care in such a scenario.
I want to assume that the nurse knew Bayless, and had a sense of those wishes. And yet, the call for an ambulance would indicate that a life-saving intervention was not against Bayless' wishes.I want to assume that the nurse knew Bayless, and had a sense of those wishes. And yet, the call for an ambulance would indicate that a life-saving intervention was not against Bayless' wishes.
But isn't something wrong with the assumption that performing CPR and rushing a dying elder to the ER is always the good and compassionate act?But isn't something wrong with the assumption that performing CPR and rushing a dying elder to the ER is always the good and compassionate act?
In the Journal of the American Medical Association in March 2012, physicians Craig Blinderman of Columbia University Medical Center and Eric Krakauer of Massachusetts General Hospital, with social scientist/bioethicist Mildred Solomon of the Hastings Center, suggested that CPR should no longer be the default option for dying patients:In the Journal of the American Medical Association in March 2012, physicians Craig Blinderman of Columbia University Medical Center and Eric Krakauer of Massachusetts General Hospital, with social scientist/bioethicist Mildred Solomon of the Hastings Center, suggested that CPR should no longer be the default option for dying patients:
"Whenever there is a reasonable chance that the benefits of CPR might outweigh its harms, CPR should be the default option. However, in imminently dying patients, a default status of full resuscitation is not justifiable. Not only is CPR in this situation likely to harm patients without compensatory benefit, the default framework likely influences patients and surrogates to request that full resuscitation is attempted even when the physician believes doing so may be inappropriate.""Whenever there is a reasonable chance that the benefits of CPR might outweigh its harms, CPR should be the default option. However, in imminently dying patients, a default status of full resuscitation is not justifiable. Not only is CPR in this situation likely to harm patients without compensatory benefit, the default framework likely influences patients and surrogates to request that full resuscitation is attempted even when the physician believes doing so may be inappropriate."
Investigation may find that CPR would have been appropriate for Lorraine Bayless, and that the nurse was as unfeeling as her recorded voice and the corporation (not to say, the person) that employed her. And yet, with CPR on an 87-year-old, if you don't crack a rib, you're not really trying. A nurse knows this.Investigation may find that CPR would have been appropriate for Lorraine Bayless, and that the nurse was as unfeeling as her recorded voice and the corporation (not to say, the person) that employed her. And yet, with CPR on an 87-year-old, if you don't crack a rib, you're not really trying. A nurse knows this.
A colleague of mine in Community Voices in Medical Ethics recently told an EMT, as she was being loaded into an ambulance, that she did not want to be resuscitated should her heart stop. But the emergency medical technician, for personal or professional reasons, said he could not honor the request.A colleague of mine in Community Voices in Medical Ethics recently told an EMT, as she was being loaded into an ambulance, that she did not want to be resuscitated should her heart stop. But the emergency medical technician, for personal or professional reasons, said he could not honor the request.
My friend's heart never stopped, and we had a laugh when she told me the story. Badly injured in a head-on collision, her recovery is ongoing. But she's healthy enough to find humor in having avoided unwanted resuscitation.My friend's heart never stopped, and we had a laugh when she told me the story. Badly injured in a head-on collision, her recovery is ongoing. But she's healthy enough to find humor in having avoided unwanted resuscitation.
EMTs did not abide my mom's DNR, and attempted heroic measures. But Mom was already gone. I'd like to think she didn't feel a thing and was enjoying the afterlife she so faithfully believed in.EMTs did not abide my mom's DNR, and attempted heroic measures. But Mom was already gone. I'd like to think she didn't feel a thing and was enjoying the afterlife she so faithfully believed in.
I know this much: the Bakersfield dispatcher demanding CPR was not there. The nurse was alone with her judgment, her employer's fear-based policy, and a dying woman.I know this much: the Bakersfield dispatcher demanding CPR was not there. The nurse was alone with her judgment, her employer's fear-based policy, and a dying woman.
It's worth noting that, according to a television reporter, Bayless' daughter "was satisfied with the care her mother received". And that Bayless' daughter is a nurse.It's worth noting that, according to a television reporter, Bayless' daughter "was satisfied with the care her mother received". And that Bayless' daughter is a nurse.
Our editors' picks for the day's top news and commentary delivered to your inbox each morning.