"Heroic" care | Hank Dunn

Compassionate, informed advice about healthcare decision making

Archive for the ‘“Heroic” care’ Category

Can a POW have a “Good Death” Hundreds of Miles from Home?

Posted February 10, 2022 by [email protected]

A young soldier named William Gaston Barringer turned 18 on October 5, 1862. Less than three months later, he was wounded and died as a prisoner of war 200 miles from home. Yet, there is evidence he had a good death. How could this be?

Barringer’s marker caught my eye as I wandered around St. Peter’s Cemetery in Oxford, Mississippi. The epitaph, “I was not afraid to die; my Mother taught me to pray in early life,” got me thinking about what it means to have a good death. (See my “Hank’s Deep Thoughts” video at the monument.)

Let me clarify; a “good death” does not mean that it was good that William died. Death to the young is, of course, a tragedy. And, as a POW, he likely did not die in ideal conditions.

Being a prisoner of war was not mentioned on the monument. I did an internet search and found him on a list of soldiers who died in captivity, hundreds of miles away in Murfreesboro, Tennessee.

A “good death” through the centuries

Plagues in the 1300s killed 40-60% of the European population. Such widespread death led to the release of a couple of books known as the Ars moriendi (“The Art of Dying”). These were Christian instructions on how to have a good death. There were accompanying woodcuts, like one showing demons tempting the dying man with crowns symbolizing earthly pride.

By the American Civil War (1861-65), the dying and their families knew what was expected. Drew Gilpin Faust identified four elements of a good death in her moving book, This Republic of Suffering: Death and The American Civil War. According to Faust, a good death in the 19^th century was one where the dying person:

Was conscious
Was not afraid of dying
Was prepared spiritually to meet their maker
Left dying words for the family

Even the atheist Charles Darwin, who died in 1882 in England, kept to this script. He told his wife on his deathbed, “I am not the least afraid of death—Remember what a good wife you have been to me—Tell all my children to remember how good they have been to me.”

Though a reference to spiritual things was conspicuously absent, Darwin was conscious, was not afraid of dying, and left last words for his family. In my interpretation, he wanted to emphasize that even though he had no spiritual leanings, he was still “not the least afraid of death.”

Much has changed since the Civil War, including our expectations about our deaths. Today, medical literaturedescribes what many now consider a good death: being in control, being comfortable and free of pain, having a sense of closure, etc.

This sense of control has recently manifested itself through eleven U.S. jurisdictions adopting medical aid in dying. In those places, patients can ask a physician to give them medication to hasten their dying.

Back to Mr. Barringer

The words on Barringer’s marker were an assurance to his family that he died a good death: “I was not afraid to die; my Mother taught me to pray in early life.” These seem like the dying words of a conscious man.

And there it is. William was conscious, he was not afraid of dying, he was prepared spiritually (thanks to his mother), and these are the words he left for others. I can imagine his mother visiting this monument often in her grief and being consoled, “At least he had a good death.”

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

“Watching” the Super Bowl on Life Support

Posted February 2, 2022 by [email protected]

“I know he would never want to be kept alive like this,” she said to me over the sound of a machine forcing air into her husband’s lungs. He lay motionless, eyes closed. He had been like this for months after arriving at the nursing home from the hospital.

She was holding out for the miracle that seemed unlikely. She was raised Catholic but converted to Judaism when they married some forty years before. One day I came into the room on my chaplain rounds, and she had both a Jewish prayer book and a Rosary in her hands. She figured it couldn’t hurt covering all the bases.

“Why is he like this?” she asked more than once, about him being in a nonresponsive state. Doctors told her he would never regain consciousness. “There must be a reason.”

When bad things happen to good people

Since she was Jewish and asked this question, I gave her a copy of Rabbi Harold Kushner’s When Bad Things Happen to Good People. After the rabbi’s three-year-old son was diagnosed with a rare disease that would take his life by his teens, he pondered the question that became his best-selling book. Rabbi Kushner believes that although God is good and loving, nature randomly metes out bad things. God does not send bad things. They “just happen.”

I dropped in again a few days later, and she thrust the book at me. “I didn’t like it,” she said. “He says some things ‘just happen’ with no reason. I can’t accept that. There has to be a reason my husband is like this.”

Withdraw life support — but first…

Just as these situations usually progress, she and her three adult sons began to ask the staff and physician about withdrawing the life support. They were told it would be quite appropriate and could be managed in a way to provide comfort.

Washington fans during the Super Bowl years

It came down to an impromptu meeting with me in the hall outside the patient’s room. “Dad would hate this,” said one of the sons. They all agreed it was time.

Then another son spoke up. “Wait a minute. We are all headed to the Super Bowl to cheer for the Redskins.” (Of course, he was referring to the Washington Football Team once known by that name.) The patient and his sons all had season tickets, a prized possession back in the day when the team won three Super Bowls in nine years.

“It would be really sad to go to the game in Minneapolis right after dad dies. Let’s do it after the game.” They all agreed.

“Watching” the Super Bowl on life support

I had heard a lot of reasons for delaying withdrawal of life support — waiting for a sibling from California to arrive at the bedside or waiting until someone gets married. Waiting for a football game was a new one for me. I could imagine the patient would have been fully behind the delay. Football means that much to some people.

I did see the compassion in this act. Perhaps having the game on in the patient’s room just might get through to this poor soul. I didn’t really believe it would, but what do I know.

The plan worked. They took the man home days after the game, where they withdrew life support, and he died peacefully.

And the Washington Football Team beat the Buffalo Bills that year, 37-24, in Super Bowl XXVI.

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Race and the Place of Death of Our Choosing

Posted November 3, 2021 by [email protected]

If you had a choice, where would you want to die? At home? In a hospital ICU? In a hospice in-patient unit?

It has only been recently that more people have died at home than in the hospital. I used to discourage death in the hospital. As a nursing home and hospice chaplain, I cared for hundreds of patients in non-hospital settings. It seemed to me that dying outside the hospital was the better way to go.

Photo by Alvin Leopold on Unsplash

When I was writing the third edition of my book, Hard Choices for Loving People, I included a section strongly discouraging people from going to the hospital to die. I sent a draft to Dr. Christina Puchalski, who leads the George Washington Institute for Spirituality and Health.

Dr. Puchalski is a pioneer in encouraging physicians to assess patients’ spiritual resources. She also was in active practice at the time, caring for patients in a Washington D.C. clinic. Many of her patients were African Americans with limited income.

She read my draft and saw through my attempt to manipulate readers. “Hank, many of my patients and their families feel more comfortable dying in the hospital,” she told me. “It is very common for people in the neighborhoods I serve to want to go to the hospital in the end.”

So, I modified that section. I listed all the possible downsides to hospitalization but acknowledged some would still prefer to go to a hospital.

A rural physician taught me a lesson

About that same time, I started traveling around the country making presentations to healthcare professionals. My most popular talk, “Helping Patients and Families with End-of-Life Decisions,” includes a series of slides with “Hank’s Theorems” on various end-of-life issues. The first slide says, “The peacefulness of a death is directly proportional to the distance from the hospital ICU.”

I was speaking at a resort in Button Bay, Vermont. A woman came up to me after my lecture and said she took issue with that slide. “I am an ICU doctor in a small rural hospital here in Vermont, and we do not have a lot of resources. We use our ICU as an in-patient hospice and have a lot of peaceful deaths there.”

Now when I show this slide, I also share this physician’s feedback. I clarify that it is the death hooked up to machines with medical staff beating on our chest that many of us want to avoid.

“Fighting to the end” or a “peaceful death”

But what about the people who want to “fight to the very end”? The ones who really do NOT want a peaceful death? Perhaps, aggressive interventions and a medicalized, violent end are their true desires. Then again, many families whose loved ones died in the ICU wish it hadn’t happened that way. They regret that their mom or dad did not have a more peaceful death.

Photo by Sharon McCutcheon on Unsplash

So, here are two extremes of what death could look like: Being hooked up to machines in the ICU or choosing comfort measures only in a non-hospital setting. An article in the Journal of the American Medical Association (JAMA)Network Open and its accompanying commentary investigated this recently.

The research looked at metastatic cancer patients who died in a hospital. Some died in the ICU or had other more aggressive treatments like mechanical ventilation, CPR, or chemotherapy before they died. Others never had these interventions. There was a curious breakdown based on race.

Black, Hispanic, and Asian patients were much more likely to have aggressive interventions before death than White patients. This research could not answer why this was the case. The commentary in JAMA speculated that perhaps it could be due to the informed decisions of the minority patients or their families.

I have cared for patients and their families who did not want the death at home. They didn’t want to face the thought of living in the house where the dead had lain. Or the patient did not want to create an extra burden for the family, which can be so common in the last days. The hospital was the best place for them to reach their goals.

Either way, the hope is that people can have the death of their choosing.

Overdiagnosis of Kidney Failure vs Normal Aging

Posted September 8, 2021 by [email protected]

We are treating elderly people for a disease they do NOT have. These treatments are burdensome, expensive, and make the patients’ lives worse, not better. More on this in a moment.

My friend was having problems with his bridgework and got a consult from a recommended dentist. Upon examination, the dentist said he could replace the old bridge and fix some other problems…for $10,000.

Needless to say, my friend got a second opinion. He went to another dentist who suggested first trying to repair the old bridge for $125 before replacing it. That was five years ago, and my friend says the less extensive solution is still holding.

I will very generously assume that the $10K dentist truly believed all his proposed work was needed. But I imagine the money played some role in the high-ball proposal.

Overtreatment is a big issue

I have written before about treatments pushed onto old folks that have no benefit. Some may even harm the patient. For example, research is clear that feeding tubes for advanced dementia patients offer no benefit and make these poor souls worse. I wrote about this here and here.

Also, the use of CPR offers certain patients no benefit and may make the possibility of a peaceful death less likely. I wrote about this here.

More recently, I wrote about a controversial, newly-approved drug that allegedly treats Alzheimer’s. It is expensive and requires the patient to receive it by IV. Worse, there is no evidence anyone’s life is improved (except maybe the shareholders in the drug company).

Now, what’s new with kidney failure?

The Journal of the American Medical Association (JAMA) Internal Medicine reported that elderly patients are routinely diagnosed with kidney failure, even though their kidney function is actually normal. This is a clear case of overdiagnosis leading to overtreatment. A related editorial also appears in the same issue of JAMA.

In 2002, the National Kidney Foundation published clinical practice guidelines on the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines were based on levels found in a patient’s blood chemistry. Patients are classified as “normal/mild,” “moderate,” or “severe.” Those with more severe conditions may be put on dialysis.

What this new research found is that our kidney function declines normally as we age. For most of us, this decline does not affect how we feel, nor does it lead to an early death. Yet, many people are dialyzed just because the “numbers” say they need it.

Why?

The JAMA authors speculate about why doctors are reluctant to adopt new guidelines based on research known since 2012. They name three possible reasons: (1) a strong belief in the magnitude of the problem and the importance of early detection; (2) a desire to maintain the status quo; or (3) financial considerations. There is much money to be made when someone is on dialysis.

In 2017, John Oliver did a piece on HBO about dialysis and the financial incentives to providers. Over 11 million people have viewed it. If you have never seen Oliver, be warned — he drops a few f-bombs and makes you laugh at a very serious subject.

This IS very serious. If you are concerned about kidney failure, seek the advice of your trusted healthcare provider. Share this new research with them. Decide what course of treatment, if any, is best for you.

Could COVID Be the New “Old Man’s Friend”?

Posted April 7, 2021 by [email protected]

Here’s the question: Should a nursing home resident with dementia get the COVID-19 vaccine?

There is no question that nursing home residents are at a high risk of dying should they get the coronavirus. That also goes for the underpaid and overworked staff who care for these vulnerable patients. One might think, “Of course, vaccinate them all.”

Not so fast.

I started thinking about this after reading a recent article from the bioethics think tank The Hastings Center, “Too Taboo to Contemplate? Refusing COVID Vaccination for Some People with Dementia.”

Just a month ago I wrote a blog post, “Making End-of-Life Decisions for Dementia Patients.” In it I wrote, “Here’s the question families of dementia patients face as they consider end-of-life decisions: Shall we save his life so he can become more demented and slowly decline further or shall we let him die peacefully?”

Dena Davis, J.D., Ph.D., takes a similar approach in her Hastings Center article. She states the obvious: that if a person had declared in an advance directive that in the case of advanced dementia, they would refuse vaccines for flu or pneumonia, then that would also apply for COVID-19 vaccine. But, what of the patient who does not have a written advance directive or has failed to give such specific verbal directions?

Dr. Davis refers to several surveys where people expressed their preference to die sooner rather than spiral down with dementia. In one survey, more than half of the respondents were either “very unwilling” or “would rather die” than live in a nursing home. In another study of seriously ill but cognitively competent people a majority believed that either incontinence or “being confused all the time” were states equal to or worse than death.

We hardly need a scientific study to convince us that losing our minds and being totally dependent on others is a state almost all of us want to avoid. Now, a novel coronavirus comes along that is especially hard on elderly nursing home patients. It is also hard on the caregivers and vaccinating patients is partly to protect these folks and their families.

I agree with Davis’s personal preference that if she had dementia and was confined to a nursing home, she would give her surrogates instructions to withhold vaccines. Me too.

Once, pneumonia was thought of as “the old man’s friend” – a relatively peaceful way for the elderly to die, a welcome visitor. Dr. Davis speculates, “Could the novel coronavirus be today’s old man’s friend?”

Don’t Say of Me, “He fought to the bitter end!”

Posted March 16, 2021 by [email protected]

“Dad was a fighter. We never gave up on him!” they said to each other.

For me, it was one of the saddest scenes I had witnessed since I started working as a chaplain in 1983.

I must emphasize that my interpretation of this scene as being sad is my opinion. This entry is about how I want to be treated in the end…or not treated as the case may be.

Others do want to “fight to the very end” and I can support that. But this case seemed beyond all reason. You can decide for yourself.

On this particular day, I was in the emergency department waiting room with the family of one our nursing home residents who had been rushed to the hospital. The patient was riddled with cancer, literally. He had tumors breaking his skin in multiple places. His body was wasted.

Earlier at the nursing home, I sat with the wife outside the patient’s room while the paramedics were beating on the man’s chest. One EMT compassionately knelt by this woman to tell her that they did not have a pulse on her husband, but they were going to continue CPR and take him to the hospital. He said he was not hopeful that they could save the man’s life. He did an admirable job of breaking bad news.

When the ER doc came out to tell the family that they were unable to revive him they said to each other, “Dad was a fighter. We never gave up on him!”

Fighting battles

This story has so many things to unpack. Ethics. Compassion. Autonomy. “First, do no harm.” Surrogate decision-making. Moral distress of the professionals. Not to mention the patient’s adult children were not speaking to his wife, their stepmother. But I’ll focus now on the language of fighting to the bitter end.

“Keeping Away Death,” sculpture by Julian Hoke Harris, located near Grady Hospital in Atlanta.

We see it often in obituaries, “John died after a long battle with cancer.”

I’m sorry. In my view, this language makes John a loser. What a horrible thing to say about him. Everybody dies. In framing death as a battle lost, we ALL will be losers when it comes to the last act of our lives.

What does this say to the millions of us who read these words and feel ashamed when we have a disease which we know will kill us? We can only conclude, “It’s my fault I am dying.”

Did I allow too much stress to cause me to get sick? Did I not try hard enough? Did I lack faith?

Let me be clear. At this point in my life, if I get a fairly treatable cancer with a good prognosis, I will “fight” it, if you must use that language. I just do not like the battle metaphor when your enemy is death. Death is part of life not its enemy.

“He died peacefully…”

What got me thinking about this is a book I listened to recently as I drove from Oxford, Mississippi to Northern Virginia. Actually, it was two short books in one audio program — Susan Sontag’s Illness as Metaphor (1978) and AIDS and its Metaphors (1988).

What Sontag only barely mentioned in the more recent book was that she was being successfully treated for breast cancer when writing the earlier one and later “fought” and “defeated” uterine cancer. She finally died fighting a rare and very aggressive form of leukemia in 2004. And fight she did.

Her son, David Rieff, wrote a very moving memoir (Swimming in a Sea of Death) about what it is like for a family member to try to support a patient who was dragging herself through a painful dying in the false hope she would be cured.

If you must mention a cause of death in my obituary say, “He died peacefully while living with cancer” or “He died peacefully after months with palliative care and hospice.” Or, better still, “He didn’t give up, he let go and just let things be.”

“Grey’s Anatomy” and CPR on Television

Posted December 9, 2020 by [email protected]

True confession: I have joined my 22-year-old daughter in binge-watching Grey’s Anatomy during the pandemic. Over 300 episodes viewed and counting. I now know about “10-blade,” “clear!” and the importance of declaring “time of death.” Also, I never knew there was so much romance and sex going on in hospital supply closets and on-call sleeping rooms. Now I know.

Grey’s Anatomy (currently in its seventeenth season) follows Dr. Meredith Grey and her fellow surgeons at a Seattle teaching hospital. She started out as a young, single intern and is now a widowed mother of three small children as well as the chief of general surgery. The show is very engaging, depicting extremely dedicated and hard-working doctors. Most are compassionate, empathetic and caring.

CPR is on TV…but it is not realistic

A staple of medical dramas is the “code.” A heart monitor starts beeping loudly, a doctor starts chest compressions, another grabs the paddles of a defibrillator and yells, “Clear!” Sometimes the first shock gets the heart back in rhythm but most often it takes a couple.

While it seems like all of the cardiac arrests on Grey’s are with a “shockable rhythm.” In real life only about 10% of cardiac arrests are shockable. Medical journals have exposed the unrealistic depiction of CPR on medical dramas.

Why dedicate medical research to the topic? The general public develops a distorted view of the success of the procedure. In 1996, the New England Journal of Medicine looked at CPR on Rescue 911, Chicago Hope and E.R. and found survival rates vastly higher than the actual 17%. On Rescue 911, 100% of those receiving CPR survived.

In 2015 the journal Resuscitation calculated the CPR survival-to-discharge success rate at 50% for House and Grey’s Anatomy. That doesn’t happen in real life. But if 83% of the CPR patients died on TV, not many people would watch it and the sponsors would probably complain.

I have written before about the futility of CPR for large categories of patients. In the years between the fifth (2009) and sixth (2016) editions of Hard Choices for Loving People, the survival rate inched up from 15% to 17%. It is not that the procedure has gotten better. The clinicians are getting better at advising patients and families about who will NOT benefit from CPR. Survival rates have improved because we are doing LESS CPR.

DNR is a big deal

Occasionally on Grey’s, the characters discuss “code status” — whether a patient should have a Do Not Resuscitate (DNR) order. (See my blog on my preference for AND — Allow Natural Death.)

On the show, it’s the patient who is often ready for the docs to write the order so they can have a peaceful death. The family — or even the physicians — sometimes resist. In my experience, this is very realistic. Real-life patients usually come to the conclusion that they are dying before their families or doctors. Their own bodies tell them it is time. This is information others do not have.

The DNR is a big deal. It serves as a sign that it is time to prepare for a comfortable and dignified death. And, on this, I do give Grey’s credit for getting it right.

Slow Down, You Are Doing Too Much

Posted August 21, 2015 by kbrachle

“Let her go in peace,” was my bottom-line message.

ER trips, IV antibiotics, bulb syringes … all had become extraordinary measures … in my view.

A woman called me out of the blue yesterday. A hospice worker had given her my Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care, and the Patient with a Life-Threatening Illness. I am not exactly sure what she wanted from me as she talked rapidly and pretty much constantly through our close to an hour on the phone.

This never-married woman was the primary caregiver for her 96-year-old mother. The old lady had suffered strokes and dementia was advancing. Because of the swallowing difficulty the daughter was forcing food into her mother’s mouth with a bulb syringe. This is a rubber device, shaped like a tear drop. You suck food into the bulb then stick the narrow end into the patient’s mouth and force the contents out.

Medical professionals encouraged the daughter to slow down

It sounds like the medical professionals in both hospice and the hospital have encouraged the daughter to slow down. But she has sent her mom to the ER three times over the last several weeks. “Maybe if they just give her some IV hydration she would start eating better,” her logic went.

Having listened for about a half hour I asked her, “What is the future for your mother?”

“She is dying.”

Bingo. She said what I was hoping for. In hundreds of such conversations over the years I have asked questions to help caregivers come to their own conclusion about the big picture.

Dying people stop eating and drinking at the end of life. Dying people probably will dehydrate leading to a more peaceful and compassionate death. Dying people talk less and sleep more. Dying people can get aspiration pneumonia once known as “the old man’s friend.”

“I feel so guilty all the time”

Then the lady moved into my chaplain’s area. “I feel so guilty all the time.” She wept.

“Guilty? For what?” Caregiver guilt is not uncommon.

Once, when she mentioned to a doctor she felt guilty for not doing enough, he said, “If you want to feel guilty about something, feel guilty for doing all this to your mother.” I wouldn’t have said it that way. But basically I suggested she start doing less.

I recommended that if she wanted her mother to have a peaceful death at home she not call the rescue squad, she not use antibiotics for aspiration pneumonia, and maybe stop using the bulb syringe. Oh…and she stop feeling guilty.

I actually have little hope she will stop feeling guilty as it has been her constant companion since childhood she told me. But I did tell her, “You can never make a wrong decision. You do the best you can with the information you have at the time. That is all we can ask of anyone. Maybe later will you look back and see how things could have been done differently. But in the moment you just do the best you can.”

Photo by Anwaar Ali on Unsplash

Choosing Death Over a Paralyzed Life

Posted November 13, 2013 by kbrachle

It is so easy to theorize about what you would do. What if you were on life support with the prospect of spending the rest of a long life as a quadriplegic on a ventilator. Would you say “good bye” to your wife who is carrying your unborn child and ask them to turn off the vent?

That is exactly what Tim Bowers did. Click here for the telling of the story.

Just over a week ago Bowers was hunting and fell sixteen feet to the ground from a deer stand. He fractured three vertebrae and damaged his spinal cord. The medical team advised his family that he would be paralyzed from the shoulders down and probably dependent on machines to breathe for him for the rest of his life. The family wanted to see if the patient could participate in the decision-making process.

“Do you want this?”

When he woke up from the sedatives that had kept him unconscious he could not speak but could answer yes-and-no questions. “Do you want this?” they asked, meaning “Do you want to be kept alive on this machine?” He shook his head “No.” They removed him from the ventilator and he died a day after the accident.

Well. Well?

This is what we in the medical community have been advocating. NOT that people be allowed to die. What we want is for patients to be involved in the decision-making that might end his or her life. They woke Bowers up and asked and he essentially said, “Let me die.”

As soon as I read this story I thought, “I know many paralyzed people on vents who might say he made the wrong decision.” Think Stephen Hawking. Sure enough I found one blogger who is paralyzed who took issue with how this case was handled.

Perhaps the decision came too soon after the injury. Law professor Thaddeus Pope wonders whether Bowers had “sufficient decision making capacity at the time he made the decision?” In states where physician assisted suicide is legal there is a waiting period from the first request for life-ending medication to a second and final request. Pope asks whether or not Bowers was fully informed about the “options and possibilities of life as a paralyzed individual.”

Give a little time

I tend to agree. Give a little time. If the patient persists in his request to be taken off the machine, by all means, comply.

Years ago I was called to the beside of a heavily sedated man on a ventilator after a heart attack. His wife explained that he had been on a vent before with his heart condition and wrote a living will so he would never be on a breathing machine again. I told the ICU nurse about my conversation and she said, “It is too soon to think about that.”

Well, he was able to get off the vent and out of ICU. I visited him a few days later. He was walking around his hospital room gathering things as he prepared for a transfer to another hospital to have a defibrillator implanted in his chest. I asked him, “How do you feel about being on a ventilator again?”

He said, “I am so glad they did?”

There you go.

A Peaceful Death . . . Without CPR

Posted March 8, 2013 by kbrachle

Who hasn’t heard it yet? The 911 dispatcher in Bakersfield, California begging the retirement home employee to find someone to begin CPR on 87-year-old Lorraine Bayless who had collapsed in the dining room. Apparently the policy at Glenwood Gardens independent living facility is to call the rescue squad and let them care for a stricken resident. Glenwood is not a medical facility but an apartment building with extra services for the elderly. The employee on the phone with the dispatcher very calmly said repeatedly “No, we don’t have anyone here who can begin CPR.”

Much of the commentary I have heard this week condemned the employee and the policy as unethical and uncaring. I am not surprised given the false information out there that CPR saves most of those who suffer a cardiac arrest.

May I offer a few things to consider.

1) CPR is rarely successful. Only 15% of those who have resuscitation attempts in the hospital survive to be discharged. Patients who do not live independently, who have more than one or two medical problems, or have a terminal disease survive in the 0-2% range. In one study of out-of-hospital cardiac arrest only 9.4 percent of those in their 80s and 4.4 percent of those 90 and older survive.

I don’t know what diagnoses this lady had but at 87 many people have several health issues which make them unlikely to survive a CPR attempt.

2) CPR itself has risks of broken ribs and punctured lungs as well as the risk of brain damage. Half of “successfully” resuscitated patients have brain damage ranging from mild memory loss to ending up in a vegetative state. I know of at least one case where a medical facility was sued for “wrongful life” because they “successfully” resuscitated a patient against the patient and family wishes. Evidently they felt the burden of living after resuscitation was much worse than death.

3) Most 87-year-olds wish for a peaceful, quick death like Ms. Bayless had. I say this having spent years as a nursing home, hospice, and hospital chaplain and caring for my parents (along with my brother and sister) as our elders made the journey from independent living, through assisted living, to a nursing home, and finally dying under hospice care. These old, old people’s greatest fear is to become demented, incontinent, wheelchair-bound, and having to live out their days dependent on others. Ms. Bayless was still in independent living. She never had to make that final decline most of us will make.

Mrs. Bayless’s family released a statement after the media frenzy. They wrote:

“It was our beloved mother and grandmother’s wish to die naturally and without any kind of life-prolonging intervention. . . . We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens, and is at peace. We also have no desire, nor is it the nature of our family, to seek legal recourse or try to profit from what is a lesson we can all learn from.”

Sounds like those with most to lose in this situation are quite accepting of the outcome.

CBS radio commentator, Dave Ross, observed that neither the employee nor a resident who also called 911 had any panic in their voice. He said:

“In fact at no time do you hear anyone crying for help or panicking—probably because they all know the policy. Not just the policy at Glenwood, but the policy that applies to us all—which states that at some point—life ends. If you’re lucky, it doesn’t end until you’re well into your 80’s—but it ends. We like to think we can change that by declaring an emergency and rushing to the rescue.

“In fact, one California legislator says she plans to introduce a bill so this never happens again. Unfortunately, I think outlawing natural death may be more than even the state of California can enforce.”

Hank Dunn