I had one signed this week. (The form is signed by a physician, not the parent.) After months of sitting on the document, I decided to finally just do it.
It wasn’t actually a fraught decision; I have always known my own limits for what interventions for Owen are acceptable and what are not. The standard form for DNR (in Ontario, anyway) includes a list of actions that paramedics are legally excused from performing, including administering certain medications, chest compressions and artificial ventilation.
After thinking about it for a long while, I settled on an acceptable (customized) list and had Owen’s physician sign it. She, and Owen’s dad, agreed with my decisions.
I then showed the form to all of our caregivers (actually, one more left…) and anyone else who figures into our everyday lives. I made clear my intentions, my decision and my rationale and was open to discussing any reactions. Everyone said they are supportive and some seemed relieved that a plan had been communicated.
This post is not about the details of the DNR or even whether or not I think you should sign one. It’s a deeply personal matter and one about which I have no judgement. Rather, I encourage you to think about how you would want an emergency handled. Decide what you must and then inform anyone who needs to know.
For me, the details of the DNR were decided strictly on the basis of Owen’s likelihood to survive the intervention and what his life might look like afterwards. However, the decision to contemplate it at all and finally get it in place was motivated (in part) by a completely different set of factors.
I currently employ 5 caregivers who collectively work approx. 50 hours a week. The chances of an emergency happening during that time are not negligible. I feel it is my responsibility to share with them the ‘master plan’, to not only help them to know what to do, but also to relieve them of the terrible burden of powerlessness and potential regret.
I am quite certain they feel the fragility of Owen’s life and it possibly crosses their minds more than occasionally that one day Owen may not be around to care for. If any one of them are so unlucky as to face a potentially fatal emergency with Owen, I would want them to remain present enough to support Owen and not have to fret about decisions and interventions. Because I have made decisions in advance, I can give my full trust and support to these fine young women. For the amount of responsibility they shoulder every time they arrive for work, it’s the least I can offer them in return.
It’s good you have done this, no matter how weird it feels to do so. You are right in that in leaves other caregivers the chance to be “present” should anything go wrong.
I have to say that we were very misinformed when we did our DNR. We were told to never call for the ambulance, as the EMR personnel HAD TO do everything with or without a DNR. I will have to look into that. Thank you for this post.
Hi Claire,
That’s an odd thing to be told! My understanding is that the DNR is specifically for EMS response, which is why they have serial numbers (they’re tracked in some way so we don’t just randomly take out DNRs on people!). The subheading says ‘to direct the practice of EMS and Firefighters after February 1 2008’. Hospitals have their own forms. Definitely worth inquiring about. Likely your form is old… here’s a bigger image: http://www.ofm.gov.on.ca/english/Publications/images/DNRC01.gif
This is an important and moving post, and a gift of clarity for the women who work with Owen, as you say.
My Dad died earlier this year of lung cancer, and when we had the discussion about his DNR, the doctor was very frank about the brutality of some of the interventions. For example, he said if Dad had a heart attack, they would put him on a board to do CPR and break all of his ribs.
It was quite an eye-opener for me. Thank you for sharing Jen.
Good advice.
I’m sure it was hard to deal with but it was a wise decision to take care of it. Thank you for sharing.