Talking with my friend, Pashta, a death midwife, always leads to interesting discoveries. As a death midwife Pashta is interesting in all matters around death and dying and so took particular interest in the changes around medical representative and do not ressusitate documents that occurred about 2 years ago. One of the issues that arose in her investigation didn’t directly have anything to do with the legislation or the preparation, but with the execution. An article I saw recently got me thinking about that issue again and triggered some thinking.
Let’s say you have all you paperwork in order, everything is in place, all your family is aware and supportive of you choice to allow your death to occur without “extraordinary measures”, you are a DNR (Do Not Ressusitate). Now what? If you have already been admited into the hospital, hospice, extended care facility, palliative care room or some such place you are okay. The administration of such places ask questions about this on admission and your wishes and paperwork will have been duly recorded and filed. Great. Or is it?
When you are out there, busy living your life and something goes awry (think stroke, etc) is when you are most likely to require/be given some pretty extreme emergency procedures to deal with the trauma. How does your DNR come into play? You have a high likelihood of being unconscious or unable to communicate. Most of us wouldn’t be carrying our paperwork, those that might would likely have something in a wallet or purse. Are you willing to bet your life, literally, that your EMT and/or ER doctor or nurse in going to look in you purse or wallet?
How do you let everyone know to leave you alone? Give you something so you do not suffer and leave you alone? More and more people are trying to solve this problem by tattooing their wishes on their body. Generally located over or around their sternum (breastbone) where anyone performing CPR or defibrilation would be looking, or at the wrist as a permanent medic alert bracelet. But, before you rush out to your local tattoo artist, ask yourself this -how many doctors or EMTs will honour a tattoo? A tattoo is permanent, but is it legal? All medical professionals are bound to provide all lifesaving measures in the absense of orders to the contrary. Many doctors report that they would not honour a DNR tattoo.
With this dilemma we run into the problem that is the log jam of so many death related issues. Can you decide to die? In Canada it has only been legal to take your own life since 1972, there is only one person in BC who currently has any recourse to request a doctor to assist her in ending her life. We have the right to vote, to fight for our countries, to do stupid and dangerous things and to live, whether we want to or not, but not the right to die. No matter how agonizing, hopeless or plain pitiful our life may be, just getting the right to end it is almost impossible. Ironically, the sicker we get, the more infirm and less able we are, the less likely we will be able to achieve our end.
Make your plans, get your tattoo, but you better start making some noise too, if you want to be sure the papers will be found, the tattoo honoured and your wishes granted. There will have to be some profound alteration in the thinking of our lawmakers, our medical caregivers, and in our society before we can expect that effort will be made to find out our wishes before action is taken. Meanwhile, make sure people – doctors, your family, and friends – know that you know what you want, and that you are counting on them to make sure you get it.