wowjili Making End-of-Life Decisions
To the Editor:
Re “Doctors Saved Her Life, Even Over Her Wishes” (front page, Aug. 28):
I read with great interest your story about when doctors don’t follow “do not resuscitate” orders. As a practicing anesthesiologist, I have been surprised by how often surgeons, operating room nurses and anesthesiologists refer to the “automatic suspension” of D.N.R. orders during a patient’s surgery or procedure. Such a practice is a violation of a patient’s fundamental right of autonomy and self-determination.
For these reasons the American Society of Anesthesiologists, the American College of Surgeons and the Association of periOperative Registered Nurses have stated since the 1990s that it’s unethical to automatically suspend D.N.R. orders in the operating room. Yet, 30 years later, I still hear this.
It is correct that some surgeries cannot be performed without a breathing tube. And treatable conditions often arise in the operating room, such as bleeding, allergic reactions or decreases in blood pressure. However, it is still entirely appropriate for patients to request that some things be off limits. Examples might include chest compressions, electrical shocks or drugs to maintain their blood pressure.
In the consent process, doctors can advise patients whether their surgery can be completed within the boundaries of what a patient is willing to consent to.
Samuel C. SeidenGranite Bay, Calif.
To the Editor:
This informative and discouraging article touches on a continuing health care crisis: an excess of unwanted medical care, particularly at life’s end. The expressed wishes of patients are too often inappropriately ignored. This must change.
A survey 10 years ago revealed that about one in four Americans ages 50 and over say that they or a family member experienced excessive or unwanted medical treatment. That is about 25 million people. Nearly two-thirds of those surveyed supported withholding payments to health care providers who do not honor their end-of-life wishes.
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