Wednesday, February 23, 2011

Zombie has second thoughts on advance directives

Death Channels: Zombie copes with his/her uncle's death and the ramifications of an advance directive "Uncle Larry" had signed over a decade earlier, in a fit of depression when he'd first been diagnosed with HIV.

One night, I was alone with Larry in his room, while the night nurse was elsewhere in the building. He was due for another morphine dose in a few hours, so the previous dose was probably starting to wear off. For the first time in days, Larry stirred, and seemed to wake up. He made a faint moaning noise. I got up and leaned closer, and for the only time during the last month of his life, he spoke. It was just two raspy words: “Help me!”

I ran into the hallway and got the nurse, describing to her what had happened. Her response? “He must be in pain!” She came in and quickly gave him another dose of morphine. Before he faded back to sleep Larry made one last gesture: He shook his head, as if to say “No no no.” And then he went unconscious again. He never woke up after that, the nurses ensuring that he was drugged up at all times. He died three days later without saying another word or regaining consciousness.

What killed him? Well, the doctors would likely say he died of AIDS. But the direct cause of his death was, basically, starvation and dehaydration. Which, I later learned, is what actually kills many patients in hospice care, who often die from the withholding of nutrition rather than from the more slow-moving effects of their terminal illnesses.


In 1996, in a fit of depression, he signed agreements that his life not be “artificially” prolonged should he become severely ill. But I have this terrible nagging feeling that once he came face to face with the real possibility of death, he wanted to stay alive. I suspect that he struggled for a month to wake up so he could revoke the “Do Not Resuscitate” order. But partly because of his condition, and partly because of the drugs he was given, he was unable to speak or move.

When one is healthy and young it’s easy to causally say, “If I get old, just unplug me!” But the young and the healthy can’t imagine what it’s like to stare death in the face and know that no one will save you because you told them not to. The will to live is truly tested and often only becomes manifest when one is at the point of death. Can we trust the wisdom of our 40-year-old selves to know how we’ll feel when we’re about to die?

Furthermore — and in Larry’s case, more troubling — can we trust end-of-life instructions that were signed by someone who may or may not have been in his right mind?


Chad Tonka said...


The article you linked to asks: can we trust end-of-life instructions that were signed by someone who may or may not have been in his right mind?

The answer to that is: obviously not.

A person not in control of their mental facilities should not sign a DNR order, engage in a mortgage contract, or sign a car lease. The point is that a person not in control of their mental facilities should not enter into ANY kind of legally-binding agreement.

After reading over the entire story about this episode, I’m left with this question: if “zombie” was conflicted over the status of DNR order, why didn’t he/she consult with a lawyer? If “zombie” was so troubled by the possibility that the order was signed by the uncle in a state of dementia, why didn’t he/she use the legal route to have it undone?

Smells fishy…


GrannyGrump said...

Chad, "Uncle Frank" was LEGALLY competent at the time he signed it -- just, as his family observed, very depressed.

If Terri Schiavo could be sentenced to death for an offhand comment her husband reported her saying, "Uncle Frank" didn't have a snowball's chance in Hell once he put his pen to paper.

The other issue, of course, is the practice of starving to death people who are still capable of eating with assistance. Why not presume that if they want to die they'll refuse food? Why shouldn't "Uncle Frank's" ACTIONS when he was sick trump something he'd signed fifteen years earlier?

His behavior was indicating a desire to live. But we as a society place no value on the sick or disabled, so we grant to them an all-encompassing "right" to die.

Chad Tonka said...


I’m unclear what you are saying, and it would help to turn down the hyperbole a little bit. If “Uncle Frank” had signed a DNR, then he needs to be an adult and change the order (if he indeed changed his decision) if his thoughts on the matter change. That’s not asking too much. The man was HIV+, so he must have had some idea that he could get very ill in the future.

The whole point of a DNR order is to give physicians guidance if the subject is suddenly incapacitated. It does not make any sense to say, “It’s okay to sign a DNR order, and then a physician will make a judgment on whether or not it is a good idea.”

His behavior was indicating a desire to live.

Highly unlikely. First off, as I indicated in my first post, “Zombie’s” story has some gaping holes in it. Second, I doubt “Zombie” had any idea what UF meant by his groans, and I know for sure that you don’t possess the slightest idea what these responses meant simply by reading “Zombie’s” story.

But we as a society place no value on the sick or disabled, so we grant to them an all-encompassing "right" to die.

Pure hyperbole. DNR orders are not a “right to die” (whatever that means). They are simply a way of expressing your desires to a medical professional should you be unable to communicate.


GrannyGrump said...

Evidently, Chad, you did not read the piece very thoroughly. "Uncle Frank" did not die because of a DNR order. He was starved to death because he signed an order for no artificial feeding -- which his doctors interpreted as ANY assisted feeding. The man was starved to death, not denied resuscitation after his heart stopped.