By Jim deMaine
Special to The Seattle Times published Saturday September 23rd
I’m 85 years old and am in reasonably good health considering my age — mild hypertension, cured prostate cancer and macular degeneration. It’s been a wonderful life and I continue to enjoy friends and family, but if my heart stops, please don’t bare my chest and shock my heart trying to get it restarted. I don’t have some kind of death wish. I’m just trying to be realistic.
Now you’ve probably heard that Seattle leads the world in successful cardiac resuscitation. It’s true! If you happen to be quite a bit younger than I am, go into cardiac arrest with someone nearby who can start cardiopulmonary resuscitation while 911 is being called, your chance of survival may be as high as 55% (elsewhere in the country a 15% survival would be a good outcome). However, in my age group, it’s less than 5% chance of survival (only one in 20) — with a significant risk of brain damage, broken ribs and winding up in a nursing home.
I’ve expressed my wishes to my doctor for do not resuscitate or intubate orders, filled out an advance directive, completed portable orders for life sustaining treatment and talked at length with my designated durable power of attorney for health care.
So why might I, against my wishes, still be at risk of undergoing CPR? Well, picture me at an exciting Mariners game where suddenly I slump over with no pulse. My DPOA-HC is not present. My forms are in my apartment. Sustaining life is the norm for our community. Likely someone will step in and begin CPR and call for an automated external defibrillator. My wishes will be unknown. If I survive, waking up with a tube in my throat in an ICU is my nightmare.
So, what can I do? Very appropriately, 911 responders will do everything to save a life unless there is an explicit order/reason not to. In California and many other states, persons like me can obtain a certified DNR bracelet or medallion, which is covered in their legal codes. In Washington, we can wear a DNR bracelet or medallion but there is not a state or 911 policy addressing their use. When I talk to the medics, I find they vary quite a bit in their opinions about the utility of DNR bracelets/medallions — they haven’t received clear training about whether to honor the engraved DNR message. Oregon has a statewide registry of Physician Orders for Life Sustaining Treatment forms stored in an electronic database, so a 911 responder can immediately locate and act on one’s stated wishes. Washington has no such registry. Some will put their wishes on a wallet card, thumb drive or cellphone — but these are not easily found in an acute emergency.
I remain uncertain if my end-of-life wishes will be followed. This needs to change. We need to respect the wishes of persons like myself who are wearing a DNR bracelet. Basically, there are two things we need to do: First, we should have statewide policy to honor a DNR bracelet/medallion. Second, we need a statewide registry of POLST forms with a rapid retrieval mechanism for 911 responders.
Many elderly people like me want to leave this Earth in a natural way without CPR. Can we make the needed changes so that these wishes will be honored?
Jim deMaine is a retired pulmonary/critical care physician living in downtown Seattle. He is an author and clinical professor of medicine at the University of Washington.