Otherwise known as "DNR."  My husband and I had a discussion about DNRs because of the recent headlines about the man who was operated on and saved by a procedure he developed for repairing dissected aortic aneurysms.  Supposedly this man had signed a DNR and something else refusing surgery to repair his aortic dissection.  But after much ethical debate, the operation was performed anyway, successfully.

My husband thinks that there shouldn't be DNRs.  He thinks that people who are dying aren't of sound mind and that even if they do sign a DNR, that it's shouldn't always be upheld.  I can see what he's getting at, but I don't agree.  Short of being depressed or psychotic or demented, what makes a dying patient any less sound of mind than one who is not dying?  And who exactly is the judge of when a DNR should be upheld or not?  He believes that a person facing their own mortality cannot be of sound mind.  I don't think that it's the dying patient that isn't thinking straight, but rather that patient's family and friends.  Because it's usually these people who are fighting the DNR if there is one.  Often, people with DNRs are those with terminal cancer or other conditions in which they know that their death is imminent.  At some point, these patients probably come to accept that they are going to die and then choose to not prolong the process with unnecessary measures.  This is when they sign those DNRs.  For the people around them who are not dying, this act may be seen as giving up rather than acceptance.  They often cannot understand why their loved one wouldn't want everything done.

I myself have felt this way before.  When my mom was dying from cancer, I found a DNR form stashed away in one our desk drawers.  I was 17 and had no idea what it was, but after reading it, I got the point.  It wasn't filled out or even signed.  So she didn't opt for it.  But the mere existence of the form freaked me out (and this was compounded by the fact that I didn't even know that she was dying at the time).  I seriously doubt that my mom was the one to decide not to sign that form.  I picture her maybe wanting to, maybe considering it, then my dad convincing her otherwise.  He was nowhere near being able to let her go.  But I think my mom was.  In her last days, she was calmer than I had ever seen her, serene even, as if a great weight had been lifted.  I was not there to witness her death, but I have to wonder how traumatic the resuscitation attempts would have been for me had I seen them.  And I wonder if my mom really had to go through that one last trauma when there really was no hope at all anyway.  I wouldn't change anything, but such cases are what I think DNRs are for: when a patient has already gone through enough and accepts that they are going to die regardless of what measures are taken.  Patients should be allowed to choose when to say enough is enough.

Back to the story that started it all.  This heart surgeon had a DNR and believed that his condition was fatal.  However, it turned out that it wasn't.  So had they upheld his DNR, he would be dead today.  And I guess that's why my husband is so against DNRs.  Because if there is even a minuscule amount of hope left, he believes one should fight.  Because who knows…you just might beat the odds.  Maybe you won't, but at least you tried.  I understand that mentality, but what we still need to consider is what the patient wants.  What if this heart surgeon didn't care that he was saved and resented his family for not allowing him to die and prolonging his low-quality-of-life life (which is not the case here)?  Maybe the patient thinks that they have lived long and fully enough and doesn't really care if they live another month or year.  Then it should be okay for them to say DNR.  But my husband doesn't agree with that.  If his mom were to have a DNR, he would fight it, regardless of her reasons.  Which brings me back to my point that it's the patient's family and friends who aren't willing to accept death.

Our collaborators on my thesis project were discussing this very notion during my last experiment: people are now living longer and longer due to advances in medicine, but what kind of life are they living?  Many of these people are miserable and are merely shells of themselves.  At some point, these people should be able to say, "enough."  But they're not allowed to because medicine can help them and because their families cannot let go.  At least let them have DNRs when it is their time to go.  At least that's what I think.  It's not an easy thing and I can't say that I haven't been guilty of not being able to let go.  Nor do I think that I would be brave or mature enough to be able to sign my own DNR come time.  But I can respect the decision of those who are.  And their family and friends should learn how to respect their decision too, even if they don't necessarily agree.

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