<?xml version="1.0" encoding="UTF-8"?><rss version="2.0"
	xmlns:content="http://purl.org/rss/1.0/modules/content/"
	xmlns:wfw="http://wellformedweb.org/CommentAPI/"
	xmlns:dc="http://purl.org/dc/elements/1.1/"
	xmlns:atom="http://www.w3.org/2005/Atom"
	xmlns:sy="http://purl.org/rss/1.0/modules/syndication/"
	xmlns:slash="http://purl.org/rss/1.0/modules/slash/"
	>

<channel>
	<title>&quot;Heroic&quot; care | Hank Dunn</title>
	<atom:link href="https://hankdunn.com/category/heroic-care/feed/" rel="self" type="application/rss+xml" />
	<link>https://hankdunn.com</link>
	<description>Information for End of Life Decision Making</description>
	<lastBuildDate>Tue, 11 Mar 2025 12:51:09 +0000</lastBuildDate>
	<language>en-US</language>
	<sy:updatePeriod>
	hourly	</sy:updatePeriod>
	<sy:updateFrequency>
	1	</sy:updateFrequency>
	<generator>https://wordpress.org/?v=6.9.4</generator>

<image>
	<url>https://hankdunn.com/wp-content/uploads/2020/02/cropped-hd-fav-32x32.png</url>
	<title>&quot;Heroic&quot; care | Hank Dunn</title>
	<link>https://hankdunn.com</link>
	<width>32</width>
	<height>32</height>
</image> 
	<item>
		<title>New Podcast with Hank — &#8220;Seeing Death Clearly&#8221; on nutrition and hydration</title>
		<link>https://hankdunn.com/2025/03/11/new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration</link>
					<comments>https://hankdunn.com/2025/03/11/new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Tue, 11 Mar 2025 12:51:09 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA["Routine" Care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Artificial Feeding Tubes]]></category>
		<category><![CDATA[Comfort Care]]></category>
		<category><![CDATA[Dementia]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=5081</guid>

					<description><![CDATA[<p>Jill McClennen asked me to come back on her &#8220;Seeing Death Clearly&#8221; podcast. This time the topic was &#8220;End-of-Life Nutrition &#38; Hydration.&#8221; We covered feeding tubes as they relate to swallowing difficulties following a stroke, cancer, or dementia. We also talked about the normal loss of appetite in the dying patient. We spent some time [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2025/03/11/new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration/">New Podcast with Hank — “Seeing Death Clearly” on nutrition and hydration</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><img fetchpriority="high" decoding="async" class="size-medium wp-image-5079 alignleft" src="https://hankdunn.com/wp-content/uploads/2025/03/SeeingDeathClearlyEpisode-300x300.jpeg" alt="" width="300" height="300" srcset="https://hankdunn.com/wp-content/uploads/2025/03/SeeingDeathClearlyEpisode-300x300.jpeg 300w, https://hankdunn.com/wp-content/uploads/2025/03/SeeingDeathClearlyEpisode-150x150.jpeg 150w, https://hankdunn.com/wp-content/uploads/2025/03/SeeingDeathClearlyEpisode-100x100.jpeg 100w, https://hankdunn.com/wp-content/uploads/2025/03/SeeingDeathClearlyEpisode.jpeg 600w" sizes="(max-width: 300px) 100vw, 300px" />Jill McClennen asked me to come back on her &#8220;Seeing Death Clearly&#8221; podcast. This time the topic was &#8220;End-of-Life Nutrition &amp; Hydration.&#8221; We covered feeding tubes as they relate to swallowing difficulties following a stroke, cancer, or dementia. We also talked about the normal loss of appetite in the dying patient. We spent some time discussing &#8220;voluntarily stopping eating and drinking&#8221; (VSED) both for the competent patient and by advance directive for the dementia patient.</p>
<p>&nbsp;</p>
<p>I discussed VSED in a previous blog post <a href="https://hankdunn.com/2022/11/10/vsed-by-advance-directive-an-alternative-to-prolonged-dying/">here</a>.</p>
<p>Here is the link to the <a href="https://seeingdeathclearly.buzzsprout.com/2092749/episodes/16760370-end-of-life-nutrition-hydration-with-hospice-chaplain-hank-dunn">podcast on Jill&#8217;s website</a>.</p>
<p>Here is the link to <a href="https://podcasts.apple.com/us/podcast/seeing-death-clearly/id1661355352?i=1000698485126">Apple Podcasts</a></p>
<p style="font-weight: 400; text-align: center;">__________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p>
<p>&nbsp;</p><p>The post <a href="https://hankdunn.com/2025/03/11/new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration/">New Podcast with Hank — “Seeing Death Clearly” on nutrition and hydration</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2025/03/11/new-podcast-with-hank-seeing-death-clearly-on-nutrition-and-hydration/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Hank on &#8220;Death Happens&#8221; podcast</title>
		<link>https://hankdunn.com/2025/02/19/hank-on-death-happens-podcast/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=hank-on-death-happens-podcast</link>
					<comments>https://hankdunn.com/2025/02/19/hank-on-death-happens-podcast/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Wed, 19 Feb 2025 13:04:06 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Death & Dying]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<category><![CDATA[death happens podcast]]></category>
		<category><![CDATA[hard choices for loving people]]></category>
		<category><![CDATA[Hospice Nurse Penny]]></category>
		<category><![CDATA[hospicenursepenny]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=5055</guid>

					<description><![CDATA[<p>I had a great conversation with Hospice Nurse Penny and Halley Hospice Social Worker  on their great podcast &#8220;Death Happens.&#8221; You can find it wherever you get your podcasts. Here is the link to the podcast  on YouTube: &#160; &#160; __________________ Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2025/02/19/hank-on-death-happens-podcast/">Hank on “Death Happens” podcast</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><img decoding="async" class="wp-image-5059 aligncenter" src="https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast-300x215.jpg" alt="" width="554" height="397" srcset="https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast-300x215.jpg 300w, https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast-1024x735.jpg 1024w, https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast-768x551.jpg 768w, https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast-600x431.jpg 600w, https://hankdunn.com/wp-content/uploads/2025/02/BordersPhotosPodcast.jpg 1376w" sizes="(max-width: 554px) 100vw, 554px" /></p>
<p>I had a great conversation with Hospice Nurse Penny and Halley Hospice Social Worker  on their great podcast &#8220;Death Happens.&#8221; You can find it wherever you get your podcasts.</p>
<p>Here is the link to the podcast  on YouTube:</p>
<p><iframe title="Hard Conversations about Hard Choices" width="500" height="281" src="https://www.youtube.com/embed/8V_Y_C_s0dw?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></p>
<p>&nbsp;</p>
<p>&nbsp;</p>
<p><img decoding="async" class="alignnone wp-image-5064" src="https://hankdunn.com/wp-content/uploads/2025/02/BordersPodcastEp12-300x279.jpg" alt="" width="372" height="343" /></p>
<p style="font-weight: 400; text-align: center;">__________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p>
<p>&nbsp;</p><p>The post <a href="https://hankdunn.com/2025/02/19/hank-on-death-happens-podcast/">Hank on “Death Happens” podcast</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2025/02/19/hank-on-death-happens-podcast/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Is This Suicide?</title>
		<link>https://hankdunn.com/2024/10/01/is-this-suicide/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=is-this-suicide</link>
					<comments>https://hankdunn.com/2024/10/01/is-this-suicide/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Tue, 01 Oct 2024 12:00:00 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA["Routine" Care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Death & Dying]]></category>
		<category><![CDATA[Emotional & Spiritual Issues]]></category>
		<category><![CDATA[Kidney Failure]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<category><![CDATA[dialysis]]></category>
		<category><![CDATA[suicide]]></category>
		<category><![CDATA[withdrawal of treatment]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4952</guid>

					<description><![CDATA[<p>“If I do this, will it be considered suicide?” This question was posed to me 34 years ago while I was the chaplain at the Fairfax Nursing Center in the D.C. suburbs of Virginia. It came to mind as I read a recent article in The New York Times. “Dialysis May Prolong Life for Older [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2024/10/01/is-this-suicide/">Is This Suicide?</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">“If I do this, will it be considered suicide?” This question was posed to me 34 years ago while I was the chaplain at the Fairfax Nursing Center in the D.C. suburbs of Virginia. It came to mind as I read a recent article in <em>The New York Times.</em></p>
<div id="attachment_4944" style="width: 300px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4944" class="size-medium wp-image-4944" src="https://hankdunn.com/wp-content/uploads/2024/09/NKDEP_Hemodialysis_Illustration_900x602-300x201.png" alt="" width="300" height="201" srcset="https://hankdunn.com/wp-content/uploads/2024/09/NKDEP_Hemodialysis_Illustration_900x602-300x201.png 300w, https://hankdunn.com/wp-content/uploads/2024/09/NKDEP_Hemodialysis_Illustration_900x602-768x514.png 768w, https://hankdunn.com/wp-content/uploads/2024/09/NKDEP_Hemodialysis_Illustration_900x602-600x401.png 600w, https://hankdunn.com/wp-content/uploads/2024/09/NKDEP_Hemodialysis_Illustration_900x602.png 900w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4944" class="wp-caption-text">Source: National Inst. of Health</p></div>
<p style="font-weight: 400;"><a href="https://www.nytimes.com/2024/09/01/health/dialysis-seniors-kidneys.html">“Dialysis May Prolong Life for Older Patients. But Not by Much,”</a> by Paula Span unpacks the results of a recent medical research study published in the <a href="https://www.acpjournals.org/doi/10.7326/M23-3028"><em>Annals of Internal Medicine</em>.</a> The researchers compared the length of life and quality of life of two groups of elderly patients with advanced kidney disease. One group started dialysis to manage their disease, and another group declined dialysis.</p>
<p style="font-weight: 400;">But the group that declined dialysis didn’t just DO NOTHING. Here’s how the <em>NY Times</em> article put it:</p>
<p style="font-weight: 400;"><em>“The alternative to dialysis goes by various names — medical management, <a href="https://www.theisn.org/wp-content/uploads/2024/01/Conservative-kidney-management-and-kidney-supporti.pdf">conservative kidney management</a></em><em>, <a href="https://www.kidneysupportivecare.org/">supportive kidney care</a></em><em>. In this scenario, nephrologists monitor their patients’ health, educating them about behavioral approaches, prescribing anti-nausea drugs like Zofran and diuretics like Lasix to reduce fluid retention, and adjusting their doses as needed.”</em></p>
<p style="font-weight: 400;">I contacted my nephrologist friend, Dr. Alvin Moss, at the West Virginia University School of Medicine. He has long been an advocate for treating kidney failure in elderly patients without resorting to dialysis. He said his patients like to call this approach, <strong>“active medical care without dialysis!”</strong></p>
<p style="font-weight: 400;">I wrote about this topic in a <a href="https://hankdunn.com/2021/09/08/overdiagnosis-of-kidney-failure-vs-normal-aging/">blog post</a> three years ago. Also, if you want to watch a humorous spin on the very serious subject of the for-profit dialysis business go to <strong><a href="https://youtu.be/yw_nqzVfxFQ?si=PxiCKXLksoo44NqS">Dialysis: Last Week Tonight with John Oliver</a>.</strong></p>
<h3 style="font-weight: 400;"><strong>Longer life with worse quality of life</strong></h3>
<p style="font-weight: 400;">It is true that those on dialysis lived longer, on average, about 25 months, where the group receiving active medical care without dialysis lived about 23 months. But the quality of life for the dialysis patients was worse.</p>
<p style="font-weight: 400;">The dialysis group spent about two weeks less at home (in a hospital or nursing home) than those getting supportive care. Almost all the dialysis patients had to travel to a center three times a week to be hooked up to a machine for several hours each visit. Yes, they lived 2 months longer, but with greater burdens.</p>
<div id="attachment_4945" style="width: 300px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4945" class="size-medium wp-image-4945" src="https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-300x225.jpg" alt="" width="300" height="225" srcset="https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-300x225.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-1024x768.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-768x576.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-1536x1152.jpg 1536w, https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-2048x1536.jpg 2048w, https://hankdunn.com/wp-content/uploads/2024/09/harry-cao-vqlWFI_LYEo-unsplash-600x450.jpg 600w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4945" class="wp-caption-text">Photo by Harry cao on Unsplash</p></div>
<p style="font-weight: 400;"><strong>Here is one patient&#8217;s approach to the dialysis decision from the <em>NY Times </em>article:</strong></p>
<p style="font-weight: 400;"><em>“Even before Georgia Outlaw met her new nephrologist, she had made her decision: Although her kidneys were failing, she didn’t want to begin dialysis.</em></p>
<p style="font-weight: 400;"><em>“Ms. Outlaw, 77, a retired social worker and pastor in Williamston, N.C., knew many relatives and friends with advanced kidney disease. She watched them travel to dialysis centers three times a week, month after month, to spend hours having waste and excess fluids flushed from their blood.</em></p>
<p style="font-weight: 400;"><em>“‘They’d come home weak and tired and go to bed,’ she said. ‘It’s a day until they feel back to normal, and then it’s time to go back to dialysis again. I didn’t want that regimen.’</em></p>
<p style="font-weight: 400;"><em>“She told her doctors, ‘I’m not going to spend my days bound to some procedure that’s not going to extend my life or help me in any way.’”</em></p>
<div id="attachment_4949" style="width: 221px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4949" class="size-medium wp-image-4949" src="https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1-221x300.jpg" alt="" width="221" height="300" srcset="https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1-221x300.jpg 221w, https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1-756x1024.jpg 756w, https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1-768x1040.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1-600x813.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/09/199006FNCFrankStopsDialysis-1.jpg 809w" sizes="(max-width: 221px) 100vw, 221px" /><p id="caption-attachment-4949" class="wp-caption-text">Nursing home patient stopped dialysis</p></div>
<h3 style="font-weight: 400;"><em> </em><strong>What happened to the patient worried about suicide?</strong></h3>
<p style="font-weight: 400;">That patient who asked me about suicide? You guessed it. He was on dialysis and had had enough. He wanted to stop the treatment and die peacefully in the nursing home. He was also a very devout Catholic and wanted assurance that stopping dialysis was not suicide.</p>
<p style="font-weight: 400;">&#8220;Of course not,&#8221; I told him. &#8220;You will be dying from kidney failure. It will be a very natural death.&#8221; He got that peaceful death he wanted.</p>
<p style="font-weight: 400; text-align: center;">__________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p><p>The post <a href="https://hankdunn.com/2024/10/01/is-this-suicide/">Is This Suicide?</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2024/10/01/is-this-suicide/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Tomatoes, No Free Will, and End-of-Life Decisions</title>
		<link>https://hankdunn.com/2024/08/29/tomatoes-no-free-will-and-end-of-life-decisions/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=tomatoes-no-free-will-and-end-of-life-decisions</link>
					<comments>https://hankdunn.com/2024/08/29/tomatoes-no-free-will-and-end-of-life-decisions/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Thu, 29 Aug 2024 16:50:13 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[CPR]]></category>
		<category><![CDATA[Emotional & Spiritual Issues]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<category><![CDATA[choice]]></category>
		<category><![CDATA[determined]]></category>
		<category><![CDATA[free will]]></category>
		<category><![CDATA[sapolsky]]></category>
		<category><![CDATA[tomatoes]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4921</guid>

					<description><![CDATA[<p>My wife does not like tomatoes, but I married her anyway. She can’t help herself. I don’t recall that our preference for or against tomatoes came up when we were dating. Does anyone think of such things to ask a potential life partner? I think not. I recently posted a video of me eating a [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2024/08/29/tomatoes-no-free-will-and-end-of-life-decisions/">Tomatoes, No Free Will, and End-of-Life Decisions</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">My wife does not like tomatoes, but I married her anyway. She can’t help herself. I don’t recall that our preference for or against tomatoes came up when we were dating. Does anyone think of such things to ask a potential life partner? I think not.</p>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4919 alignleft" src="https://hankdunn.com/wp-content/uploads/2024/08/SandwichFeature-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2024/08/SandwichFeature-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/08/SandwichFeature-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/08/SandwichFeature.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" />I recently posted a <a href="https://youtu.be/EqAjwL9p1TE?si=aFjMrD3I2fnxiER0">video of me eating a tomato sandwich</a>, just bread, mayonnaise, and thick, juicy, farm-fresh tomatoes. I closed the reel commenting that there is no free will in whether we like tomatoes, “Perhaps there are more things we think we are making choices about, but we really aren’t.”</p>
<p style="font-weight: 400;">NOT ONE of the many comments on the post picked up on the lack of free will. Everyone wanted to talk about their love of tomatoes and all the different ways to eat them. Our love (or dislike) of tomatoes is an easy example of how we lack free will.</p>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4916 alignright" src="https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-225x300.jpeg" alt="" width="225" height="300" srcset="https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-225x300.jpeg 225w, https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-768x1024.jpeg 768w, https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-1152x1536.jpeg 1152w, https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-1536x2048.jpeg 1536w, https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-600x800.jpeg 600w, https://hankdunn.com/wp-content/uploads/2024/08/IMG_4326-scaled.jpeg 1920w" sizes="(max-width: 225px) 100vw, 225px" />A lot goes into acquiring a taste for a food: where you grew up, what your family ate in your childhood, textures you like or dislike, or how a particular food settles in your stomach. You don’t “choose” to like a tomato, you either do or don’t based on many factors outside of your control.</p>
<p style="font-weight: 400;">Judgement or pride have no place when you accept that there is no free will in a liking for tomatoes. There is no judgement by us tomato lovers toward those who dislike them. Heck, more are available for me if a certain portion of the population dislikes them. Conversely, there is no sense of pride or achievement by those of us who have attained such a refined palate to appreciate a fine tomato. We are just the lucky ones.</p>
<h3 style="font-weight: 400;"><strong>Free will and “choice” in end-of-life decisions</strong></h3>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-2755 alignright" src="https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786-190x300.jpg" alt="" width="190" height="300" srcset="https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786-190x300.jpg 190w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786-647x1024.jpg 647w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786-768x1215.jpg 768w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786-600x949.jpg 600w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-Sixth-Edition-for-Blog-scaled-e1724948326786.jpg 832w" sizes="(max-width: 190px) 100vw, 190px" />I have made a career of helping patients and families with end-of-life decisions as a healthcare chaplain and author of <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a>, </em>which has sold over 4 million copies. The first chapter on CPR discusses the “choice” a caregiver may need to make to put a frail or elderly patient through a resuscitation attempt.</p>
<p style="font-weight: 400;">I remember the scores of patients and families I helped make end-of-life decisions as a nursing home chaplain. Most often, once I explained that only about 1% of nursing home patients survive the event that led to CPR and survivors are in much worse shape than before, the families would say, “No CPR. Let her go in peace.”</p>
<p style="font-weight: 400;">But occasionally, they would say, “Life is precious no matter how poor, and a 1% chance IS a chance. We love grandma and don’t want her to die,” and then the patient remained a full code.</p>
<p style="font-weight: 400;">Did these families exercise their free will in making these choices? What if the “choice” was not <em>consciously made</em> by the caregiver but resulted from a series of factors and information leading up to the decision?</p>
<h3 style="font-weight: 400;"><strong>Determined: A Science of Life without Free Will</strong></h3>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4926 alignleft" src="https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-300x300.jpg" alt="" width="300" height="300" srcset="https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-300x300.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-1024x1021.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-150x150.jpg 150w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-768x765.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-600x598.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover-100x100.jpg 100w, https://hankdunn.com/wp-content/uploads/2024/08/SapolskyBookCover.jpg 1210w" sizes="(max-width: 300px) 100vw, 300px" />Last year, Robert M. Sapolsky started making the media rounds, including a <a href="https://www.nytimes.com/2023/10/16/science/free-will-sapolsky.html?smid=nytcore-ios-share&amp;referringSource=articleShare"><em>New York Times</em> interview</a> and a guest appearance on <a href="https://www.samharris.org/podcasts/waking-up-conversations/we-really-dont-have-free-will">Sam Harris’ <em>Making Sense</em> podcast</a>. He has a new book, <a href="https://a.co/d/8KzzIo5"><em>Determined: A Science of Life without Free Will</em></a>. Yes, THAT free will.</p>
<p style="font-weight: 400;">Sapolsky presents a credible argument that we are not making “choices” the way we think we are, based on the science of our brains. Here’s an excerpt of his argument:</p>
<p style="font-weight: 400;"><em>“Once you work with the notion that every aspect of behavior has deterministic, prior causes, you observe a behavior and can answer why it occurred: because of the action of neurons in this or that part of your brain in the preceding second. And in the seconds to minutes before, those neurons were activated by a thought, a memory, an emotion, or sensory stimuli.…We are nothing more or less than the cumulative biological and environmental luck, over which we had no control, that has brought us to any moment.”*</em>(see his full 4-paragraph summary below)</p>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-2309 alignright" src="https://hankdunn.com/wp-content/uploads/2011/09/CPR-did-it-for-me-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2011/09/CPR-did-it-for-me-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2011/09/CPR-did-it-for-me-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2011/09/CPR-did-it-for-me.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" />What about that family who “chose” a full code for their frail, failing, nursing home patient? Maybe they watched <em>Rescue 911</em> on TV, where 100% of patients getting CPR survived (see my <a href="https://hankdunn.com/2020/12/09/greys-anatomy-and-cpr-on-television/">previous blog about CPR on TV).</a> Perhaps this previous exposure to all of the CPR successes on TV makes them say, “Yes, do everything,” without even thinking about it.</p>
<h3 style="font-weight: 400;"><strong>Why present a choice if there is no free will?</strong></h3>
<p style="font-weight: 400;">So why would I take the time to explain CPR and present a “choice” to use it or not, if there is no free will to make that choice? Maybe they did not know about the 1% survival rate. This new information might connect to millions of bits of data previously registered in the family’s brains, activating an assessment that Grandma would likely not survive.</p>
<p style="font-weight: 400;">I’d also have these conversations because I can’t help myself. I am compelled by forces within my brain, formed over years of experience, for which I have no control: Talking about end-of-life decisions was part of my job, family values instilled in me from my youth was to do your duty on the job, the long line of nurses in my family fostered a natural compassion for these patients and families.</p>
<p style="font-weight: 400;">I believe the scientific evidence Sapolsky presents that we have no free will is quite compelling. Most people may disagree, citing religious and spiritual arguments over whether or not we have free will.</p>
<p style="font-weight: 400;">Humor me on this one. If there is no free will, we must be less judgmental of those who “choose” a path we feel is wrong. If they’re basing that decision on information spanning generations, they couldn’t help themselves. Conversely, I can’t take credit if my actions led to more compassionate end-of-life care for a patient. I had nothing to do with all that went into their family’s “choices.”</p>
<p style="font-weight: 400;">In this brief blog, I cannot begin to cover what it took Sapolsky over 500 pages to say, but I added a larger excerpt of his book below.</p>
<p style="font-weight: 400;">Now I’ve got to go back to the farmer’s market because I am out of tomatoes. I can’t help myself.</p>
<p><img loading="lazy" decoding="async" class="alignnone wp-image-4913" src="https://hankdunn.com/wp-content/uploads/2024/08/IMG_4330-300x225.jpeg" alt="" width="579" height="302" /></p>
<p style="font-weight: 400; text-align: center;">__________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p>
<p style="text-align: center;">_________________________________________</p>
<p style="font-weight: 400;">*Below is the summary of the basic thesis by Robert M. Sapolsky in his book, <em>Determined: A Science of Life without Free Will</em>, pages 3-4</p>
<p style="font-weight: 400;">“Once you work with the notion that every aspect of behavior has deterministic, prior causes, you observe a behavior and can answer why it occurred: as just noted, because of the action of neurons in this or that part of your brain in the preceding second. And in the seconds to minutes before, those neurons were activated by a thought, a memory, an emotion, or sensory stimuli. And in the hours to days before that behavior occurred, the hormones in your circulation shaped those thoughts, memories, and emotions and altered how sensitive your brain was to particular environmental stimuli. And in the preceding months to years, experience and environment changed how those neurons function, causing some to sprout new connections and become more excitable, and causing the opposite in others.</p>
<p style="font-weight: 400;">“And from there, we hurtle back decades in identifying antecedent causes. Explaining why that behavior occurred requires recognizing how during your adolescence a key brain region was still being constructed, shaped by socialization and acculturation. Further back, there’s childhood experience shaping the construction of your brain, with the same then applying to your fetal environment. Moving further back, we have to factor in the genes you inherited and their effects on behavior.</p>
<p style="font-weight: 400;">“But we’re not done yet. That’s because everything in your childhood, starting with how you were mothered within minutes of birth, was influenced by culture, which means as well by the centuries of ecological factors that influenced what kind of culture your ancestors invented, and by the evolutionary pressures that molded the species you belong to. Why did that behavior occur? Because of biological and environmental interactions, all the way down?</p>
<p style="font-weight: 400;">“As a central point of this book, those are all variables that you had little or no control over. You cannot decide all the sensory stimuli in your environment, your hormone levels this morning, whether something traumatic happened to you in the past, the socioeconomic status of your parents, your fetal environment, your genes, whether your ancestors were farmers or herders. Let me state this most broadly, probably at this point too broadly for most readers: we are nothing more or less than the cumulative biological and environmental luck, over which we had no control, that has brought us to any moment.”</p><p>The post <a href="https://hankdunn.com/2024/08/29/tomatoes-no-free-will-and-end-of-life-decisions/">Tomatoes, No Free Will, and End-of-Life Decisions</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2024/08/29/tomatoes-no-free-will-and-end-of-life-decisions/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Hospice Nurse Julie Says Suffering is Worse Than Dying</title>
		<link>https://hankdunn.com/2024/05/24/hospice-nurse-julie-says-suffering-is-worse-than-dying/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=hospice-nurse-julie-says-suffering-is-worse-than-dying</link>
					<comments>https://hankdunn.com/2024/05/24/hospice-nurse-julie-says-suffering-is-worse-than-dying/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Fri, 24 May 2024 12:37:20 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Comfort Care]]></category>
		<category><![CDATA[Hospice]]></category>
		<category><![CDATA[Hospitalization]]></category>
		<category><![CDATA[death]]></category>
		<category><![CDATA[hospice]]></category>
		<category><![CDATA[hospice nursing]]></category>
		<category><![CDATA[hospicenursejulie]]></category>
		<category><![CDATA[suffering]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4768</guid>

					<description><![CDATA[<p>Julie McFadden was just interview by “Hospice News.” That would be HospiceNurseJulie to her 347K followers in Instagram, 1.5M followers on TikTok, and 420K subscribers on YouTube. AND she just taped a show with Dr. Phil. Julie also has a book coming out in June, Nothing to Fear: Demystifying Death to Live More Fully. It’s [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2024/05/24/hospice-nurse-julie-says-suffering-is-worse-than-dying/">Hospice Nurse Julie Says Suffering is Worse Than Dying</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">Julie McFadden was just interview by <a href="https://hospicenews.com/2024/05/17/beyond-the-bedside-a-hospice-nurse-works-to-change-the-conversation-on-death/?utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=115181">“Hospice News.”</a> That would be HospiceNurseJulie to her 347K followers in Instagram, 1.5M followers on TikTok, and 420K subscribers on YouTube. AND she just taped a show with Dr. Phil.</p>
<div id="attachment_4766" style="width: 300px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4766" class="size-medium wp-image-4766" src="https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-300x183.webp" alt="" width="300" height="183" srcset="https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-300x183.webp 300w, https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-1024x626.webp 1024w, https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-768x470.webp 768w, https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-1536x939.webp 1536w, https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg-600x367.webp 600w, https://hankdunn.com/wp-content/uploads/2024/05/Author-photo_Photo-courtesy-of-Julie-McFadden-2048x1252.jpg.webp 2048w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4766" class="wp-caption-text">Photo-courtesy-of-Julie-McFadden</p></div>
<p style="font-weight: 400;">Julie also has a book coming out in June, <em><a href="https://a.co/d/8b5GEI5">Nothing to Fear: Demystifying Death to Live More Fully.</a></em></p>
<p style="font-weight: 400;">It’s a great short interview. Here are some excerpts:</p>
<p style="font-weight: 400;">Reflecting on her work as an ICU nurse, she said, “We think [death is] the worst possible thing that could happen, and I think that causes a lot of undue suffering. And suffering to me is far worse than death.”</p>
<p style="font-weight: 400;">“I do feel like it was kind of traumatic to be an ICU nurse, at least for me. Hospice was a slower pace. I was in people’s homes. There was a lot of autonomy.”</p>
<p style="font-weight: 400;">“Even as an experienced ICU nurse, I feel like I didn’t understand the scope of how our bodies really take care of us, even at the end of life.”</p>
<p style="font-weight: 400;"><strong>[The interviewer asked] “Can you expound on that a little bit? What are some of the ways that our bodies take care of us?”</strong></p>
<p style="font-weight: 400;">“For example, almost everyone wasn’t hungry, wasn’t eating and drinking, and they were sleeping a lot of the time.…. When you start getting towards the end of life, your body knows it. So it starts like turning off that hunger and thirst mechanism in the brain, because it knows that it doesn’t really need that anymore.”</p>
<p style="font-weight: 400;">Read it for yourself. Check it out at <a href="https://hospicenews.com/2024/05/17/beyond-the-bedside-a-hospice-nurse-works-to-change-the-conversation-on-death/?utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=115181">“Hospice News.”</a></p>
<p style="font-weight: 400; text-align: center;">_____________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p>
<p style="font-weight: 400;"><p>The post <a href="https://hankdunn.com/2024/05/24/hospice-nurse-julie-says-suffering-is-worse-than-dying/">Hospice Nurse Julie Says Suffering is Worse Than Dying</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2024/05/24/hospice-nurse-julie-says-suffering-is-worse-than-dying/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Ambivalent? Please, Make Up Your Mind! Or Not!</title>
		<link>https://hankdunn.com/2024/05/03/ambivalent-please-make-up-your-mind-or-not/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=ambivalent-please-make-up-your-mind-or-not</link>
					<comments>https://hankdunn.com/2024/05/03/ambivalent-please-make-up-your-mind-or-not/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Fri, 03 May 2024 12:09:47 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[CPR]]></category>
		<category><![CDATA[Death & Dying]]></category>
		<category><![CDATA[Emotional & Spiritual Issues]]></category>
		<category><![CDATA[ambivalence]]></category>
		<category><![CDATA[DNR]]></category>
		<category><![CDATA[end-of-life decisions]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4747</guid>

					<description><![CDATA[<p>The old man had come to our nursing home from the hospital in declining health with late-stage dementia. Almost immediately upon arrival, he had a medical crisis. Because he was a “full code” (everything should be done to save his life in a medical emergency), the nursing staff called 911, and he was off to [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2024/05/03/ambivalent-please-make-up-your-mind-or-not/">Ambivalent? Please, Make Up Your Mind! Or Not!</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">The old man had come to our nursing home from the hospital in declining health with late-stage dementia. Almost immediately upon arrival, he had a medical crisis. Because he was a “full code” (everything should be done to save his life in a medical emergency), the nursing staff called 911, and he was off to the hospital again. I rode with him in the ambulance.</p>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4749 alignleft" src="https://hankdunn.com/wp-content/uploads/2024/05/AmbivalentFeature-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2024/05/AmbivalentFeature-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/05/AmbivalentFeature-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/05/AmbivalentFeature.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" />While waiting for the daughter’s arrival, the ER doc asked me, “What is his code status?” I told him.</p>
<p style="font-weight: 400;">Part of my role as the nursing home chaplain was to talk to all new patients and/or their families about advance directives and the possibility of a “No CPR” order. This resident was so new to us that I had no time to contact the daughter, the decision-maker in this case.</p>
<h3 style="font-weight: 400;"><strong>Explaining the need for a “No CPR” order</strong></h3>
<div id="attachment_4753" style="width: 300px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4753" class="size-medium wp-image-4753" src="https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-300x169.jpg" alt="" width="300" height="169" srcset="https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-300x169.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-1024x576.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-768x432.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-1536x864.jpg 1536w, https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash-600x338.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/05/kier-in-sight-archives-KzneUZvYQQI-unsplash.jpg 1920w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4753" class="wp-caption-text">Photo by Kier in Sight Archives on Unsplash</p></div>
<p style="font-weight: 400;">The daughter arrived at the ER and went directly to her father’s side. He was responsive and not actively dying (though he would indeed die within a week). With her permission, I offered a prayer. I then asked her to come into the hallway so we could talk.</p>
<p style="font-weight: 400;">She was still dressed in business attire, having rushed over from a corporate or government office in the D.C. metro area. She seemed well-informed, intelligent, caring and involved. An ideal audience for my “No CPR” discussion.</p>
<p style="font-weight: 400;">I explained CPR and its lack of success in saving patients in her father’s condition. She seemed to understand and said she wanted her dad to be comfortable, knowing the end was near. I told her she would need to request a “No CPR” order from the physician.</p>
<h3 style="font-weight: 400;"><strong>Surprise indecision</strong></h3>
<div id="attachment_4745" style="width: 300px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4745" class="size-medium wp-image-4745" src="https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294-300x200.jpg" alt="" width="300" height="200" srcset="https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294-300x200.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294-1024x682.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294-768x512.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294-600x400.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/04/pexels-shvets-production-8413294.jpg 1280w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4745" class="wp-caption-text">Photo by SHVETS production</p></div>
<p style="font-weight: 400;">A few days later, the man returned to the nursing home. To my surprise, he was still a “full code.” I thought, “Didn’t she listen to me? She seemed to want comfort only and no CPR.” I called her and went through my standard spiel about the lack of benefits of CPR.</p>
<p style="font-weight: 400;">The daughter stopped me mid-spiel. She said, “I know CPR will not save my father’s life. I want him to die peacefully. But it is just so hard letting go.”</p>
<p style="font-weight: 400;">I wrote her off as “ambivalent.” I didn’t think she could make up her mind. Turns out, it was the emotional act of calling the doctor to request a “No CPR” order that symbolized her holding on — not letting go. She was trapped in ambivalence; she didn’t want her father to die…but she wanted him to have a peaceful death.</p>
<h3 style="font-weight: 400;"><strong>Frustration with ambivalent patients/families among providers</strong></h3>
<p><img loading="lazy" decoding="async" class=" wp-image-4743 alignright" src="https://hankdunn.com/wp-content/uploads/2024/04/GeriPalAmbivalence-300x189.jpg" alt="" width="442" height="267" />This story about this patient and his daughter came to mind as I listened to a recent GeriPal podcast, <a href="https://geripal.org/ambivalence-in-decision-making-a-podcast-with-joshua-briscoe-bryanna-moore-jennifer-blumenthal-barby-olubukunola-dwyer/#transcript">“Ambivalence in Decision-Making.</a>” The two physician hosts discuss the topic with three bioethicists and a doctor. You can listen to the podcast, watch it on YouTube, or read a transcript. Dr. Josh Briscoe discusses this thoroughly in a substack post, “<a href="https://familymeetingnotes.substack.com/p/ambivalence-in-clinical-decision">Ambivalence in Clinical Decision-Making: Or, Having Your Cake and Eating it Too</a>.”</p>
<p style="font-weight: 400;">Healthcare providers — doctors, nurses, social workers, and chaplains — see this all the time. We can feel frustrated that people can’t make up their minds. Did I not explain it well enough? Do they need more information?</p>
<p style="font-weight: 400;">One of the guests on the podcast note, “Ambivalence should be a flag that something’s going on here, something’s important, and we should slow down and pay attention to that.”</p>
<p style="font-weight: 400;">They then go on to reframe this indecision as a good thing, saying that ambivalent decision makers “are really sitting with their options and sitting in that tension. And that for us, felt almost like [it was] a good thing. Look how seriously someone’s taking this decision, right? They really want to make sure they get it right and that it’s a choice they can live with.”</p>
<p style="font-weight: 400;">At the end of my story, the daughter did request the “No CPR” order. Her dad died a few days later, peacefully.</p>
<p style="font-weight: 400; text-align: center;">_____________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em> and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p><p>The post <a href="https://hankdunn.com/2024/05/03/ambivalent-please-make-up-your-mind-or-not/">Ambivalent? Please, Make Up Your Mind! Or Not!</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2024/05/03/ambivalent-please-make-up-your-mind-or-not/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Toby Keith Quit Chemo</title>
		<link>https://hankdunn.com/2024/02/27/toby-keith-quit-chemo/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=toby-keith-quit-chemo</link>
					<comments>https://hankdunn.com/2024/02/27/toby-keith-quit-chemo/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Tue, 27 Feb 2024 12:27:52 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Comfort Care]]></category>
		<category><![CDATA[Emotional & Spiritual Issues]]></category>
		<category><![CDATA[Hospice]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<category><![CDATA[chemotherapy]]></category>
		<category><![CDATA[comfort care]]></category>
		<category><![CDATA[hospice]]></category>
		<category><![CDATA[toby keith]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4698</guid>

					<description><![CDATA[<p>“I quit chemo…and it probably did more damage to me than the cancer did&#8230;.” This was Toby Keith’s feelings about chemotherapy, according to his friend Brett Favre. So, is the takeaway to never do chemo? Absolutely NOT. Country singer Toby Keith was diagnosed with stomach cancer in 2021. About six months later, he announced to [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2024/02/27/toby-keith-quit-chemo/">Toby Keith Quit Chemo</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">“I quit chemo…and it probably did more damage to me than the cancer did&#8230;.” This was Toby Keith’s feelings about chemotherapy, <a href="https://www.yahoo.com/entertainment/toby-keith-quit-chemotherapy-months-194518317.html?guccounter=1&amp;guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&amp;guce_referrer_sig=AQAAAHnxAYg70VkvCokFoKrbikrjzzb0y-U-CNQ5BJ-6Sy0ufg1gYsWNGEcPV0i9lPnBFOvodeFX_kh0naVGdnbF1AinunU073NyiroHw5LBxVA1xtlDu6oWfDjkinrvSe04HQ-yeXem_DomM3Pn3ACu5_8yZT9S_JblF3PCJvEuXHh5#:~:text=Brett%20Farve%2C%20who%20was%20a,long%20battle%20with%20stomach%20cancer.">according to his friend Brett Favre</a>.</p>
<p style="font-weight: 400;">So, is the takeaway to never do chemo? Absolutely NOT.</p>
<div id="attachment_4696" style="width: 300px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4696" class="size-medium wp-image-4696" src="https://hankdunn.com/wp-content/uploads/2024/02/TobyKeithFeature-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2024/02/TobyKeithFeature-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/02/TobyKeithFeature-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/02/TobyKeithFeature.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4696" class="wp-caption-text">Photo by Hiroshi Tsubono on Unsplash</p></div>
<p style="font-weight: 400;">Country singer Toby Keith was diagnosed with stomach cancer in 2021. About six months later, he announced to his fans on social media that he was receiving chemotherapy, radiation, and surgery.</p>
<p style="font-weight: 400;">“So far, so good,” Mr. Keith wrote in a June 2022 <a href="https://www.nytimes.com/2022/06/13/arts/music/toby-keith-stomach-cancer.html?searchResultPosition=8">statement on multiple social media platforms.</a> “I need time to breathe, recover, and relax. I am looking forward to spending this time with my family. But I will see the fans sooner than later. I can’t wait.”</p>
<div id="attachment_4691" style="width: 300px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4691" class="size-medium wp-image-4691" src="https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-300x221.jpg" alt="" width="300" height="221" srcset="https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-300x221.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-1024x755.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-768x566.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-1536x1133.jpg 1536w, https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow-600x442.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/02/FinalLasVegasShow.jpg 1866w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4691" class="wp-caption-text">Keith&#8217;s last concert in Las Vegas, (TobyKeith.com)</p></div>
<p style="font-weight: 400;">Indeed, he got back out there and played a series of shows in Las Vegas less than two months prior to his death a few weeks ago. In an <a href="https://www.nytimes.com/2024/02/06/arts/music/toby-keith-dead.html?searchResultPosition=3">interview right before he died</a>, he said, “Cancer is a roller coaster. You just sit here and wait on it to go away — it may not ever go away.”</p>
<p style="font-weight: 400;">“[Keith] handled it with grace and faith and family and stood up to the cancer as good as you can,” said the former Green Bay Packers quarterback. “[But] I think in the end he was just tired,&#8221; Favre added.</p>
<p style="font-weight: 400;">We can hardly base treatment decisions on one man’s experience. Mr. Keith, diagnosed at age 60, made his decision based on the type of cancer he had and his own unique goals of care at that stage in the disease.</p>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4697 alignleft" src="https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun-300x188.jpg" alt="" width="300" height="188" srcset="https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun-300x188.jpg 300w, https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun-1024x640.jpg 1024w, https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun-768x480.jpg 768w, https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun-600x375.jpg 600w, https://hankdunn.com/wp-content/uploads/2024/02/NYTimesDeathAnnoun.jpg 1388w" sizes="(max-width: 300px) 100vw, 300px" />I am guessing if, during that last phone call, Favre asked, “Do you regret getting the chemo?” Keith might have responded, “Not at all.” Perhaps it bought him some time. Maybe, earlier in the treatment, he did not think it was causing “more damage… than the cancer.”</p>
<p style="font-weight: 400;">In my years as a hospice chaplain, I got to see patients after they had stopped treatments that were meant to cure the disease. Heck, you can’t get into hospice unless you stop curative treatments. Many expressed similar sentiments as Toby Keith. In medical-speak, “the burdens outweighed the benefits.” There, perhaps, was a time when the benefits were greater, but no more.</p>
<p style="font-weight: 400;">Or, to paraphrase Ecclesiastes in the Hebrew Bible, “There is a time for chemo and a time for no chemo.”</p>
<p style="font-weight: 400;">Let go and let be.</p>
<p style="font-weight: 400; text-align: center;">_____________________</p>
<p style="font-weight: 400;">Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books <em><a href="https://hankdunn.com/product/hard-choices-for-loving-people/">Hard Choices for Loving People</a></em>and <em><a href="https://hankdunn.com/product/light-in-the-shadows/">Light in the Shadows</a></em> (also available on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=sr_1_1?crid=3UNO2L0DJURMU&amp;keywords=hard+choices+for+loving+people&amp;qid=1700152081&amp;sprefix=hard+choices+for+%2Caps%2C126&amp;sr=8-1">Amazon</a>).</p>
<p style="font-weight: 400;">Follow Hank: <a href="https://www.linkedin.com/in/hank-dunn-m-div-99455b12/">LinkedIn</a> | <a href="https://www.instagram.com/hospicechaplainhank/">Instagram</a> | <a href="https://www.facebook.com/Hardchoicesforlovingpeople">Facebook</a> | <a href="https://www.youtube.com/channel/UCkU39FLgWVoqxzELW_M8uhA">YouTube</a></p><p>The post <a href="https://hankdunn.com/2024/02/27/toby-keith-quit-chemo/">Toby Keith Quit Chemo</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2024/02/27/toby-keith-quit-chemo/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>A Pacemaker for a 93-Year-Old with Dementia   —   I Have Some Questions</title>
		<link>https://hankdunn.com/2023/09/28/a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions</link>
					<comments>https://hankdunn.com/2023/09/28/a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Thu, 28 Sep 2023 17:07:22 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Comfort Care]]></category>
		<category><![CDATA[Dementia]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4568</guid>

					<description><![CDATA[<p>More than 200,000 pacemakers are implanted each year in the U.S. 70% go to patients over age 65, many of whom see improved quality of life and probably have their lives extended. Recently, someone contacted me because she has a friend “who is struggling with the decision for her 93-year-old mother who has dementia regarding [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2023/09/28/a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions/">A Pacemaker for a 93-Year-Old with Dementia   —   I Have Some Questions</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<div id="attachment_4570" style="width: 285px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4570" class="size-medium wp-image-4570" src="https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-285x300.jpg" alt="" width="285" height="300" srcset="https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-285x300.jpg 285w, https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-973x1024.jpg 973w, https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-768x808.jpg 768w, https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-1460x1536.jpg 1460w, https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg-600x631.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/09/BostonScientificPacemakerChest.jpg.jpg 1761w" sizes="(max-width: 285px) 100vw, 285px" /><p id="caption-attachment-4570" class="wp-caption-text">Credit: Boston Scientific</p></div>
<p style="font-weight: 400;">More than 200,000 pacemakers are implanted each year in the U.S. 70% go to patients over age 65, many of whom see improved quality of life and probably have their lives extended.</p>
<p style="font-weight: 400;">Recently, someone contacted me because she has a friend “who is struggling with the decision for her 93-year-old mother who has dementia regarding the insertion of a pacemaker.”</p>
<p style="font-weight: 400;">I am not a doctor and do not like to give medical advice, but I do have some questions for the family to ponder as they make this decision.</p>
<h3 style="font-weight: 400;"><strong>Questions:</strong></h3>
<ul>
<li>Did the patient ever indicate her feelings about life-prolonging medical procedures in the condition she now finds herself?</li>
<li>How did the patient feel about her dementia?</li>
<li>Is she happy with the state she finds herself in?</li>
<li>What would you want if you were her?</li>
<li>What would the patient think about living longer, knowing she will lose more of her mind and become more and more feeble?</li>
<li>Has the family considered enrolling the patient in hospice and focusing on the comfort of the patient?</li>
<li>Would the patient rather die than continue to decline into more memory loss?</li>
</ul>
<h3 style="font-weight: 400;"><strong>Care of dementia patients at the end of life is personal for me</strong></h3>
<div id="attachment_4517" style="width: 300px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4517" class="size-medium wp-image-4517" src="https://hankdunn.com/wp-content/uploads/2023/08/HankMom-Feature-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2023/08/HankMom-Feature-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/08/HankMom-Feature-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/08/HankMom-Feature.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" /><p id="caption-attachment-4517" class="wp-caption-text">Hank and his mother at her memory care facility</p></div>
<p style="font-weight: 400;">I blogged previously about my parents’ deaths in <a href="https://hankdunn.com/2012/01/11/how-did-your-mom-feel-about-her-dementia/">“How Did Your Mom Feel About Her Dementia?”</a> and <a href="https://hankdunn.com/2012/04/29/a-tale-of-two-docs/">“A Tale of Two Docs.”</a></p>
<p style="font-weight: 400;">Both of my parents died with dementia. We were always looking for procedures we could NOT do to allow a peaceful and sooner death. For example, we decided if either came down with pneumonia, we would not seek a cure but would keep them comfortable. My brother, sister, and I felt we handled their ends how THEY would have wanted.</p>
<div id="attachment_2878" style="width: 264px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-2878" class="size-medium wp-image-2878" src="https://hankdunn.com/wp-content/uploads/2021/01/HamptonDunn4-264x300.jpg" alt="" width="264" height="300" srcset="https://hankdunn.com/wp-content/uploads/2021/01/HamptonDunn4-264x300.jpg 264w, https://hankdunn.com/wp-content/uploads/2021/01/HamptonDunn4-600x681.jpg 600w, https://hankdunn.com/wp-content/uploads/2021/01/HamptonDunn4.jpg 766w" sizes="(max-width: 264px) 100vw, 264px" /><p id="caption-attachment-2878" class="wp-caption-text">Hank with his nursing home resident father</p></div>
<p style="font-weight: 400;">After a year and a half in a memory care unit, my mother fell and fractured her pelvis. This is a known death sentence for a dementia patient. We didn’t even have her sent to the emergency room. The hospice doc ordered pain medication, and I flew from Virginia to Colorado to be with her.</p>
<p style="font-weight: 400;">After more than four years in a nursing home, declining from Parkinson’s and strokes, my father could no longer be hand-fed. There was NO discussion about a feeding tube. I flew to Tampa to be with him, where he died six days after his last intake of food or water.</p>
<p style="font-weight: 400;">Sometimes, questions are better than answers.</p>
<p style="text-align: center;">________________________</p>
<p>Chaplain Hank Dunn is the author of <em>Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness</em> and <em>Light in the Shadows.</em> Together, they have sold over 4 million copies. You can purchase his books at <a href="https://hankdunn.com/purchase-books/">hankdunn.com</a> or on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X">Amazon</a>.</p><p>The post <a href="https://hankdunn.com/2023/09/28/a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions/">A Pacemaker for a 93-Year-Old with Dementia   —   I Have Some Questions</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2023/09/28/a-pacemaker-for-a-93-year-old-with-dementia-i-have-some-questions/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>Words Matter: “Want” and “Need”</title>
		<link>https://hankdunn.com/2023/08/03/words-matter-want-and-need/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=words-matter-want-and-need</link>
					<comments>https://hankdunn.com/2023/08/03/words-matter-want-and-need/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Thu, 03 Aug 2023 14:14:18 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[CPR]]></category>
		<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4453</guid>

					<description><![CDATA[<p>The ethics committee turned to me, “Chaplain Dunn, we will have you talk to all the patients and families about ‘No CPR’ orders and advance directives.” I was just six months into a part-time chaplain’s position for which I had no training. The arc of my career was set for the next forty years in [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2023/08/03/words-matter-want-and-need/">Words Matter: “Want” and “Need”</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<p style="font-weight: 400;">The ethics committee turned to me, “Chaplain Dunn, we will have <em>you</em> talk to all the patients and families about ‘No CPR’ orders and advance directives.” I was just six months into a part-time chaplain’s position for which I had no training. The arc of my career was set for the next forty years in this one assignment.</p>
<p style="font-weight: 400;">Four decades later, I am still learning our words matter.</p>
<h3 style="font-weight: 400;"><strong>“Need” implies you have no choice</strong></h3>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4462 alignright" src="https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-300x190.jpg" alt="" width="300" height="190" srcset="https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-300x190.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-1024x647.jpg 1024w, https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-768x485.jpg 768w, https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-1536x971.jpg 1536w, https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo-600x379.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/08/JAMALanguageRedo.jpg 1718w" sizes="(max-width: 300px) 100vw, 300px" />I read a recent <em>JAMA Online</em> article titled “<a href="https://jamanetwork.com/journals/jama/fullarticle/2807810?guestAccessKey=9dc88e76-a643-4ab0-986e-c509c540b97b&amp;utm_source=silverchair&amp;utm_medium=email&amp;utm_campaign=article_alert-jama&amp;utm_content=olf&amp;utm_term=072423">Reconsidering the Language of Serious Illness</a>,” which illustrates that when healthcare professionals use the word “need,” aggressive treatment is often the result. Example statements from the article:</p>
<ul>
<li><em>“If her breathing gets any worse, she will need to be intubated.”</em></li>
<li><em>“He needs a central line, a special IV catheter in his neck, so we can give him blood pressure medicines.”</em></li>
<li><em>“If she doesn’t make any urine soon, she will need dialysis.”</em></li>
<li><em>“If she can’t be extubated soon, she will need a trach.”</em></li>
</ul>
<p style="font-weight: 400;">The article’s authors argue that once you say the word “need,” it implies that the family has no choice but to proceed with the treatment. Who would deny their mother what she NEEDS?</p>
<h3 style="font-weight: 400;"><strong>“To need is to lack something essential”</strong></h3>
<p style="font-weight: 400;">From the article: <em>“</em><em>To need is to lack something essential. As clinicians, we regularly use the word </em>need<em> to think about and describe the condition of patients with acute serious illness. These patients lack something essential for survival, and clinicians have the technologies and therapies to sustain their lives. So </em>need<em> rolls off our tongues as a shorthand to convey our clinical assessments of patients with acute life-threatening illness.”</em></p>
<p style="font-weight: 400;">Their suggestion for changing the language: <em>“</em><em>When a patient is facing a life-threatening illness, instead of saying she ‘needs to be intubated,’ we suggest that clinicians say, ‘Her illness is getting worse. I would like to talk with you about what this means and what to do next.’”</em></p>
<p style="font-weight: 400;">This language change opens the conversation up to more options than just “the need to be intubated.” What does the patient think about their current situation? What are her preferences about being kept alive on a machine? What are her chances that she will ever get off the vent? Intubation is one possible choice, but others are equally possible, including shifting the focus from cure to comfort.</p>
<h3 style="font-weight: 400;"><strong><img loading="lazy" decoding="async" class="size-medium wp-image-2726 alignright" src="https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition-189x300.jpg" alt="" width="189" height="300" srcset="https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition-189x300.jpg 189w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition-645x1024.jpg 645w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition-768x1220.jpg 768w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition-600x953.jpg 600w, https://hankdunn.com/wp-content/uploads/2020/11/HCLP-5th-Edition.jpg 806w" sizes="(max-width: 189px) 100vw, 189px" />Changing “What does the patient WANT?” to “What does the patient THINK…”</strong></h3>
<p style="font-weight: 400;">Six years ago, I made a significant change in the language in one sentence in my <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X/ref=tmm_pap_swatch_0?_encoding=UTF8&amp;qid=1690420834&amp;sr=8-1"><em>Hard Choices for Loving People</em></a> book. Once again, a medical journal article convinced me to change a question I had used for almost three decades. I wrote about this in a previous blog, “<a href="https://hankdunn.com/2017/08/28/you-cant-get-what-you-want/">You Can’t Get What You Want.</a>”</p>
<p style="font-weight: 400;">Since the first edition of <em>Hard Choices </em>in 1990, I have included <strong>“What does the patient want?”</strong> as one of five questions to ask as an aid to making end-of-life decisions. In 2017, I changed it to: <strong>“What does the patient think about their current and probable future condition?”</strong></p>
<h3></h3>
<h3 style="font-weight: 400;"><strong>A career using language to help with end-of-life decisions </strong></h3>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4214 alignleft" src="https://hankdunn.com/wp-content/uploads/2023/01/living-will-300x154.jpg" alt="" width="300" height="154" srcset="https://hankdunn.com/wp-content/uploads/2023/01/living-will-300x154.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/01/living-will-600x309.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/01/living-will.jpg 700w" sizes="(max-width: 300px) 100vw, 300px" />Soon after I became a part-time nursing home chaplain in 1983, our administration formed an ethics committee. Virginia had just passed a “Natural Death Act,” which gave patients a right in the code to refuse treatment and provided a form (e.g., “living will”) to express their treatment preferences.</p>
<p style="font-weight: 400;">The committee included the director of nursing, the medical director, a lawyer, an administrator, and me. In response to the new law, our plan was to inform all patients and their families about advance directives and the option of a “No CPR” order. But who would deliver the information?</p>
<p style="font-weight: 400;">The committee turned to me, “Chaplain Dunn, we will have <em>you</em> talk to all the patients and families about ‘No CPR’ orders and advance directives.” I had no healthcare experience and had yet to take basic chaplain training. So, I learned how to talk to patients and families…by talking to patients and families</p>
<p style="font-weight: 400;">Over the next year, we went from less than 10% of our patients having an advance directive and/or “No CPR” order to over 80%. And I learned the importance of using my words to help the process along.</p>
<p style="font-weight: 400;">We published the first edition of <em>Hard Choices for Loving People</em> seven years later.</p>
<p>[Cover Photo by Kampus Production via Pexels]</p>
<p style="text-align: center;">________________________</p>
<p>Chaplain Hank Dunn is the author of <em>Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness</em> and <em>Light in the Shadows.</em> Together they have sold over 4 million copies. You can purchase his books at <a href="https://hankdunn.com/purchase-books/">hankdunn.com</a> or on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X">Amazon</a>.</p><p>The post <a href="https://hankdunn.com/2023/08/03/words-matter-want-and-need/">Words Matter: “Want” and “Need”</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2023/08/03/words-matter-want-and-need/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
		<item>
		<title>“He coded, but God brought him back to us!”</title>
		<link>https://hankdunn.com/2023/07/27/he-coded-but-god-brought-him-back-to-us/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=he-coded-but-god-brought-him-back-to-us</link>
					<comments>https://hankdunn.com/2023/07/27/he-coded-but-god-brought-him-back-to-us/#respond</comments>
		
		<dc:creator><![CDATA[hank@hankdunn.com]]></dc:creator>
		<pubDate>Thu, 27 Jul 2023 14:24:55 +0000</pubDate>
				<category><![CDATA["Heroic" care]]></category>
		<category><![CDATA[Advance Care Planning]]></category>
		<category><![CDATA[Death & Dying]]></category>
		<category><![CDATA[Emotional & Spiritual Issues]]></category>
		<category><![CDATA[Spirituality]]></category>
		<category><![CDATA[Withdrawing Life Support]]></category>
		<guid isPermaLink="false">https://hankdunn.com/?p=4442</guid>

					<description><![CDATA[<p>Can we “know” what God wants? His last days were filled with great suffering, played out publicly on social media and in the national news from March until his death on May 19th. Here are the descriptions of the patient’s condition in the last weeks of life: April 26th, GoFundMe post: “He has now lost [&#8230;]</p>
<p>The post <a href="https://hankdunn.com/2023/07/27/he-coded-but-god-brought-him-back-to-us/">“He coded, but God brought him back to us!”</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></description>
										<content:encoded><![CDATA[<h3 style="font-weight: 400; text-align: center;"><strong>Can we “know” what God wants?</strong></h3>
<p style="font-weight: 400;">His last days were filled with great suffering, played out publicly on social media and in the national news from March until his death on May 19<sup>th</sup>. Here are the descriptions of the patient’s condition in the last weeks of life:</p>
<ul>
<li><strong>April 26th, GoFundMe post: </strong><em>“H</em><em>e has now lost 80 pounds and subsequently continues to struggle with extreme weakness.</em><em>… </em><em>He’s on strong IV antibiotics three times a day</em><em>.…</em><em> He has intermittently also suffered [from] kidney issues and [has] been on dialysis. In addition to this, he is having heart and lung concerns, sores from being in bed for 4 months and depression.”</em></li>
<li><strong>April 30th, Facebook post:</strong> <em>“He was admitted to the hospital tonight with acute kidney failure and dehydration.”</em></li>
<li><strong>May 9th, Facebook post: </strong><em>“He will be having emergency surgery tomorrow. Still in ICU fighting the infection and organ failure.”</em></li>
</ul>
<p style="font-weight: 400;">Later, his wife refused to withdraw life support, claiming on Facebook, <em>&#8220;He&#8217;s a fighter, and his will is strong even if his body isn&#8217;t. God is our hope.&#8221;</em></p>
<h3 style="font-weight: 400;"><strong>What does God want in a VERY serious illness?</strong></h3>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4436 alignright" src="https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-300x200.jpg" alt="" width="300" height="200" srcset="https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-300x200.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-1024x683.jpg 1024w, https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-768x512.jpg 768w, https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-1536x1024.jpg 1536w, https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash-600x400.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/07/insung-yoon-Mj6C32u_1XA-unsplash.jpg 1920w" sizes="(max-width: 300px) 100vw, 300px" />Can we know what God wants? I was drawn to this story reading the pleas for people of faith to pray for a miracle when one could read between the lines and understand that this man was dying.</p>
<p style="font-weight: 400;">Let me be clear: If I were the chaplain in this story, I would approach this patient and his family compassionately and without judgment. As their chaplain, my role would be to meet this family where they are, not where I want them to be.</p>
<p style="font-weight: 400;">But I was not their chaplain and now have the luxury of pondering this situation from afar after it ended.</p>
<h3 style="font-weight: 400;"><strong>Is God ONLY for saving a life?</strong></h3>
<p style="font-weight: 400;">I find many things curious about the language and theology expressed publicly.</p>
<ul>
<li style="font-weight: 400;">Let’s start with an earlier<strong> GoFundMe post from March:</strong> <em>“He coded, but God decided that it was not his time to go and brought him back to us.”</em> Evidently, the patient’s heart failed, yet he continued to live after the intervention of CPR.</li>
</ul>
<p style="font-weight: 400;"><img loading="lazy" decoding="async" class="size-medium wp-image-4434 alignleft" src="https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-300x225.jpg" alt="" width="300" height="225" srcset="https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-300x225.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-1024x768.jpg 1024w, https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-768x576.jpg 768w, https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-1536x1152.jpg 1536w, https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash-600x450.jpg 600w, https://hankdunn.com/wp-content/uploads/2023/07/cory-mogk-Wn77gCRoegs-unsplash.jpg 1920w" sizes="(max-width: 300px) 100vw, 300px" />The family saw this as a sign of God’s intervention. The skeptic might say, “God did not decide the patient should not die during that code. Human intervention went against what seemed to be God’s plan.”</p>
<p style="font-weight: 400;">Who am I to say God did or did not intervene? I stopped speaking for God years ago.</p>
<p style="font-weight: 400;">I believe it is a slippery slope to claim that God is saving the life of someone in multiple system failure when the death expectancy rate for all of us is 100%.</p>
<h3 style="font-weight: 400;"><strong>Perhaps “God called him home?” Acceptance or crisis of faith?</strong></h3>
<p style="font-weight: 400;">There is another way people of faith might approach such circumstances. Other families I have ministered to chose to forgo heroic medical interventions. When the patient died, they said, “God called them home.”</p>
<p style="font-weight: 400;">I am guessing that this patient’s wife probably accepted “God’s timing” when her husband finally died. I hope that is true. People who feel God is in control of everything can often shift to acceptance when death eventually occurs.</p>
<p style="font-weight: 400;">But for some who expect a miracle, death can cause a crisis of faith. I wrote about this in a previous blog, <a href="https://hankdunn.com/2022/03/24/god-has-a-lot-of-explaining-to-do/">“God has a lot of explaining to do.”</a></p>
<h3 style="font-weight: 400;"><strong>What is keeping this patient alive? The machines or God?</strong></h3>
<ul>
<li><strong><img loading="lazy" decoding="async" class="size-medium wp-image-4440 alignright" src="https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-300x162.jpg" alt="" width="300" height="162" srcset="https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-300x162.jpg 300w, https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-1024x552.jpg 1024w, https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-768x414.jpg 768w, https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-1536x828.jpg 1536w, https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-2048x1105.jpg 2048w, https://hankdunn.com/wp-content/uploads/2023/07/CBSHeadlineWifeRefused-600x324.jpg 600w" sizes="(max-width: 300px) 100vw, 300px" />May 7th, Update! </strong><em>“The doctors are continuing to try and prepare me for the worst. And I continue to explain to them that [we] are people of faith and that our God has the final say. I am not in denial about what’s happening to him or blind to what the medical reports say…. I just know that the God I serve is greater than any infection and more powerful than any organ failure.”</em></li>
</ul>
<p style="font-weight: 400;">There would have been a time long ago when death was not optional. Antibiotics and other medical interventions can now cure many who would have died in another time and place.</p>
<p style="font-weight: 400;">These same modern medical treatments can also prolong the dying process, sometimes at the cost of great pain and suffering for the patient.</p>
<h3 style="font-weight: 400;"><strong>Other hopes besides “not dying”</strong></h3>
<p style="font-weight: 400;">I try to help families see that there are other outcomes to hope for other than “not dying.” Having a peaceful death, being pain-free, or spending quality time with family. This is what I did with the man who told me, <a href="https://hankdunn.com/2021/10/13/god-has-told-me-my-wife-is-not-going-to-die/">“God has told me my wife is not going to die.”</a></p>
<p style="font-weight: 400;">I don’t know how the end came for this man. I only saw <a href="https://itrwrestling.com/news/funeral-information-released-for-superstar-billy-graham/?fbclid=IwAR1hKzDfwVMu6Ccz6tQjLyyNrYKDYZTPptt6uQGStM3kR7-1KaIIKG6rQJI">the announcement of his death</a> and an <a href="https://www.nytimes.com/2023/05/19/sports/superstar-billy-graham-dead.html?searchResultPosition=1">obituary in the New York Times</a>, after which the Facebook and GoFundMe pages went silent.</p>
<p style="font-weight: 400;">Hopefully, all involved, living and dead, are now at peace.</p>
<p>[Cover photo by <a href="https://unsplash.com/@illest_shinobi?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText">Richard Catabay</a> on <a href="https://unsplash.com/photos/05kHY7AYCp8?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText">Unsplash</a>]</p>
<p style="text-align: center;">_________________________</p>
<p>Chaplain Hank Dunn is the author of <em>Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness</em> and <em>Light in the Shadows.</em> Together they have sold over 4 million copies. You can purchase his books at <a href="https://hankdunn.com/purchase-books/">hankdunn.com</a> or on <a href="https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X">Amazon</a>.</p><p>The post <a href="https://hankdunn.com/2023/07/27/he-coded-but-god-brought-him-back-to-us/">“He coded, but God brought him back to us!”</a> first appeared on <a href="https://hankdunn.com">Hank Dunn</a>.</p>]]></content:encoded>
					
					<wfw:commentRss>https://hankdunn.com/2023/07/27/he-coded-but-god-brought-him-back-to-us/feed/</wfw:commentRss>
			<slash:comments>0</slash:comments>
		
		
			</item>
	</channel>
</rss>
