Do Not Resuscitate: On Death, Dying and Alzheimer's
All long term healthcare facilities ask the next of kin whether or not to resuscitate in the form of a Do Not Resucitate (DNR) order in case the decision needs to be made. When considering a DNR order in the end stage of Alzheimer’s disease it is important you know the relevant circumstances.
DNR orders only applies to cardiopulmonary resuscitation, more commonly known as CPR, in an emergency situation.
Cardiopulmonary resuscitation (CPR) is an emergency procedure used when someone goes into cardiac arrest, and in some circumstances, respiratory arrest. The aim of CPR is to create an artificial circulation by pressing on the patient’s chest to manually pump blood through the heart. Artificial respiration is used to ventilate the lungs and pass oxygen in to the blood at the same time.
A DNR order does not exclude other medical interventions should they be needed. So, for example, medical staff will always discuss how aggressively you want treatments for your loved one should he/she break their hip, get a respiratory infection or cancer.
The most common approach in end-stage Alzheimer’s is to provide treatment to make the patient as comfortable and pain free as possible. It is important that relatives are included in treatment plans. Medical staff and relatives can then work together to provide the best care for people in end-stage Alzheimer’s.
Why Plan Ahead?
Making decisions on end of life care for someone with Alzheimer’s disease is made much easier for caregivers and relatives if advanced directives, that include living wills, have been prepared prior to illness. People in the early stages of AD can still be competent enough to state their wishes. Caregivers are often asked for their assistance.
Making decisions at times of crisis or at the end of life can be very difficult. Emotions are aroused, family disputes, financial stress and situations that have not been anticipated can cause huge problems. It is far better to plan ahead and have living will directives in place. It requires thought and open, honest communication. You need to discuss your wishes with family members or a proxy.
Preparing Advanced Directives and Living Wills
Advanced directives should include a living will. It should designate durable power of attorney for healthcare, including guidelines on the wishes of the patient in the event they may need to be resuscitated. It should specify that the power of attorney should follow the guidelines of the living will.
When making advanced directives you should consider consulting someone with relevant expertise in that area.
Contacts for Legal Advice on Advanced Directives Including Living Wills
Help is available from your local Alzheimer’s Association office. They can suggest local elder law attorneys. Alternatively you can call the Alzheimer’s Association at 1-800-272-3900
National Academy of Elder Law Attorneys can provide information and referrals. They can also be contacted by telephone 520-881-4005
Contact your local Area Agency on Aging or the Eldercare Locator at 1-800-677-1116 or .
Partnership in Caring :America’s Voices for the Dying gives a lot of information on planning and issues on end of life issues.
The Medicare Rights Center may also be helpful
Free legal advice may also be available in your community.
Christine Kennard wrote about Alzheimer’s for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.