Due to a number of recent events the subject of “No heroic efforts” resuscitation has come into discussion.
Seems to me a very difficult and “unpredictable” thing to define. For instance if a person is in a car accident, in good health and has excellent odds of a full recovery but needs “Heroic efforts” in order to stabilize them how does that work if they have a living will that states “No heroic efforts”? Are “Heroic efforts” somehow defined in ones living will? If so how does one separate the above scenario from an “End of life” scenario where the “Heroic efforts” are just putting off an eventual death?
Paramedics or other emergency room treaters won’t have access to a DNR or living will and thus usually won’t have to consider that language under those circumstances.
That is why the term is a catch-all rather than a description of actions to be taken or avoided. If you want to address the issue, get with your primary care physician and discuss. Or the primary care for your parents, etc. The rules differ from State to State, but the biggest issue is having a statement of desires in your medical file. (Hard for the medical staff to carry out your desires if they do not know of them.)
What most people think of when they hear “heroic measures” is somebody rubbing a couple of paddles together and yelling “Clear!” Those circumstances would be covered by a “DNR” Do Not Resusitate order. Other types of order include directions for palliative care (Keep me drugged up to my eyeballs and feed me, think Terri Shivo from FL), whether you want antibiotics, etc.
So at what point is the living will taken into consideration?
Say you get into an accident, you’re taken to the hospital but need a night or two in ICU with some level of life support. Do they do that or not? Is there some point where “Heroic efforts” start and “Stabalizing” ends? I would guess that one could somehow define the conditions of “Heroic efforts” in ones will, say “Brain death” or something like that.
So really creating the “Heroic efforts” portion of ones living will would include some discussion with a medical professional and getting “What you want” in laymen s terms into “Medical terms”? Does one go to their GP or some other MD for something like that?
The living will is taken into consideration when it is brought to the attention of the health care provider. Unfortunately, that is often after the person has been “saved” and the difficult questions arise about whether to pull the plug. There is no sure-fire way to avoid the hard cases. The best thing to do is to make sure that you have a clearly defined statement as to what kind of treatment or life support you do and don’t want. Share that with your next of kin and pray you never have to use it.
So really creating the “Heroic efforts” portion of ones living will would include some discussion with a medical professional and getting “What you want” in laymen s terms into “Medical terms”?
Yes.
**Does one go to their GP or some other MD for something like that? **
This is where practicality kicks into the game. You want to have the discussion with the individual most likely to be treating you (or whoever). If a GP is your primary care physician, that is the person. If your main doctor these days is a cardiologist, that is the one. What happens is that when you call for your next appointment, tell them that you want to go over end of life issues. Many practices will set you up with a clipboard and a check the box form. You can ask questions and then review with your doctor. Medical practices may set limits on what they are willing to do or not do. If you go over your desires, and your doctor goes along with you, you increase your chances of having them obeyed.
If the practice tells you to bring a copy of your living will, advanced health care directive, health care power of attorney, etc., do it and be sure to review with your physician. There are lots of no or low cost opportunities for getting legal work done on this topic.
As for what the paramedics do in the field, it again varies with what their independent authority includes, but they are going to err on the side of delivering you to the hospital in some form of alive. If you have been hanging on for a while and there have been a number of paramedic runs, you can make them aware of a DNR. (Again, different rules for different places on whether they can comply with it.)
Suggestion is to not think of any treatments as an either/or kind of black line but instead to recognize that different treatments will be appropriate under different circumstances.