www.byzcath.org Forums General Discussions Town Hall Question on a DNR order

My wife is in a nursing home and it has become obvious to us that she is very slowly dying. There is so much wrong with her body that I cannot cover it all. She is paralyzed from a stroke, her kidneys are failing, is blind from diabetic retinopathy, and her level of congnition is, we are told, around 1 - 3 on a scale of 1 - 30, 30 being fully alert and aware of one's surroundings. She is on a respirator 24/7 and as such, seems to be falling prey to constant infections.

Last night the hospital called to inform us that she has fluid in one lung and to get permission to treat her. During my conversation with her doctor this morning, the subject of a "DNR order" (Do Not Rescuscitate) came up and the doctor asked if I had considered entering one because of her bad and steadily declining health.

Is such an order against the moral teachings of the Church? I know it is wrong to not give her basic necessary care such as food and water, but what about an order to simply leave her in the hands of God if she "codes" and her heart stops?

I wish to be obedient to the teachings of the Church, and I am confused as to what to do at this moment. The rest of the family had a teleconference and decided that the DNR would be appropriate, given the quality of her life and the possibility that she may be suffering. (we are not sure on this one).

I appreciate your answers and help.

Thank you.

Brother Ed

Dear Brother Ed,

First my prayers go out to you in this most difficult of situations.

I think that so you can get all of your questions answered regarding this situation, you should contact your local parish and diocese offices. They have someone that can assist you in questions and provide you with answers. A friend of mine that is a priest went through this only in the past two years. When he called the local diocese where his mother lived, they provided all the information so that he could make an informed decision in this regard.

Many posters can offer a number of different replies, but I would strongly sugggest you contact your parish priest and the diocese regarding this matter as soon as possible.

Again my unworhty prayers for you during this trial.

In IC XC,
Father Anthony+

Brother Ed,

I agree with Father Anthony in that first and foremost, we are praying for you, your wife and all your loved ones.

I also agree with his advice to seek help "in person".

However, the Catholic Church does have a general answer to your question, and the answer is that the Church understands your pain and doesn't want to impose on you an additional burden.

If medical treatment is too imposing and the chances of success are too slim, it is morally acceptable to refuse (or deny, if personal refusal is not possible) such treatment.

Let me quote the Catechism of the Catholic Church:

Shalom,
Memo

There is a word in the reply I am unfamiliar with.

What is meant by palliative care?

Thank you

Brother Ed

Brother Ed, first let me state that I feel for you and your wife. I will keep you both in my prayers.

Palliative care is usually for symptom control and pain management. I believe the Church has put this part in the Catechism to guide doctors as to when it is morally permissive to prescribe narcotics and pain medicine that would normally be immoral in the eyes of the Church. Drugs like morphine and other strong pain medications can be used in these cases even though they are usually forbidden for normal people. And the Church states that it is a form of Charity (Caritas) to provide such for those who are suffering.

Hi,

Efforts not necessarily expected to work as a cure.

Administering morphine to terminal patients just to reduce pain, for example.

Perhaps (personal opinion), even administering placebos, when there is nothing else to do, hoping to bring at least some psychological comfort.

Shalom,
Memo

Brother Ed,

Your posts here and on other boards have been a great encouragement to me. I am therefore especially sorry to hear of this stage of the struggle. My prayers are for you and your wife in these terrible days.

CDL

Dear Lord grant your abundant mercy, peace, and wisdom to be poured out upon Brother Ed that he may hear your Word and be healed.

Any counsel I might give has already been provided by others on this forum and my relative newness to the teachings of the Church tend to disqualify me anyway, but allow me to say God bless you and may His grace carry you through this difficult time.

In Christ, Ryan

Dear Brother Ed,

Prayers for you and your wife!

Ed:

My prayers, too, for you and your wife in this trying time of your lives together.

I had this same question posed to me when I had the Medical Power of Attorney for an elderly uncle two years ago. I, too, went to my spiritual father and asked for guidance--basically to confirm what I already thought should be my response.

My uncle had had a stroke that was followed by periodic episodes that, each time, took him to the brink of death. Each time he was given medications that turned his situation around but each time left him much weaker than he had been prior to the treatment. Finally his physician came to me and we did discuss this area. Fortunately I had had the ability to talk to my uncle during his "up" periods. He told me definitely and strongly that he was not afraid to die and was, in fact, looking forward to seeing the Lord and those who had gone before him. He said that he had talked this whole matter over with the chaplain who came to see him periodically. So when the last episode came, together with another stroke, the staff let him "go on to bigger and better things" as he and I used to put it.

I know that your situation is different because your wife cannot communicate. And it is your wife. I'd be lost without my wife and I cannot honestly say what I would do. Thank God that I have not had to face this yet because I'm probably not ready for this test of faith. I do, however, have to echo the sentiments put forward by Father Anthony and others--get to your spiritual father, pastor, confessor and ask him what your moves should be. Then be at peace with the Lord and with your conscience.

May the Lord lift you up at this time and give you the confidence of His Unfailing Care for both your wife and you.

In Christ,

BOB

Prayers for you in this difficult time.

I want to point out one thing no one else has. What the medical community considers "death" may not be what you consider death to be. While lower brain functioning, heart functioning, and lung functioning do exist on their own, some doctors would consider the patient dead because of a lack of higher brain functioning (such as in the case of Terri Schiavo). Some doctors do not administer routine medications (such as antibiotics) or make regular visits when the patient has a DNR on file. It is important that you remain your wife's advocate, clearly communicating your wishes for her care to the medical staff, and that you trust her doctor to carry out those wishes. Make sure you discuss these difficult issues with someone in your area who is familiar with the church's expectations as well as the medical terminology to help guide you through the DNR process, and if you so desire the organ donation process.

In the mean time, this might interest you:
http://www.ncbcenter.org/eol.asp


My prayers are with you in this difficult time.

My heart goes out to you, as my mother has been unable to speak or command her muscles, even to scratch her head. This has gone on for five years yet every day she teaches me patience and perserverance.

A DNR order is permissible and the circumstances seem to justify it. However be careful if a Living Will is suggested; you do not have to have one. Should you sign one, it must be carefully worded because some institutions will not even permit feeding. I was told by DRMC (DuBois) that to put my Mother in Hospice they would discontinue her feeding through a G-tube; we could not even object. Needless to say, we rejected Hospice and continue to care for her at home.

As Father said, talk to your pastor and may Christ grant you peace with your decision.

Paul:

If I were you, I'd pursue this idea that the institution has anything to say about discontinuing feeding, when a Living Will specifies it, with my attorney.

I've dealt with Living Wills for many years in my professional capacity, helping people get to an attorney to have one drafted. I've seen hundreds of them completed. I have never heard of an institution being able to override a Living Will or tell anyone what they can or cannot do. The usual form has a checklist for things that a person does or does not want. That makes the document have the legal authority it has, once it is signed and notarized. In addition, you need a Medical Power of Attorney to be able to interpret it as circumstances change and questions arise. NEVER allow anyone else to interpret the Living Will, not even your physician.

I had a situation like that with an elderly uncle. He had a stroke, his throat was paralyzed so he could not swallow, his Living Will said "no surgery," and the physicians were just going to let him die even though the Living Will said he was to be fed and hydrated. I had the Medical POA. I called the doctor and surgeon and told them I was overriding the instruction because no one would starve or die of thirst under my care so they'd better get a feeding tube into him pronto. When they objected, I told them IF he died while they dallied, I would take them to court and on to the Medical Board for malpractice. They inserted a feeding tube rather quickly--about as fast as it took to get the surgeon scrubbed and the operating room ready.

You must take AGGRESSIVE actions on behalf of someone in your care to see that their dignity and life is respected. And NEVER take the word of doctor, nurse, or institution as gospel, because you have the rights and don't have to be bullied. Words like "I'll own you" and "You'll be on 60 Minutes" seem to work wonders. In our area, the name of the local injury attorney who advertises on TV doesn't hurt either: makes them all snap to attention.

BOB