Saturday, January 19, 2013

End of Life Lexicon

Here's a few definitions regarding end of life:

1. Autonomy:  Independence freedom, as of the will or one's actions:  the autonomy of the individual (From dictionary.com)

2.  Patient Autonomy:  The patient is allowed the freedom to make the best medical decision based on the best available information about all possible options.  The desire of caregivers to treat the patient as an individual person

3.  Real Patient Autonomy:  The patient is lead down a certain path, given one or two options, and lead to believe he made the best decision on his own.  Most people are naive about medical options and trust their physician to make the right choice for them.

4.  Do Not Resuscitate (DNR):  I want to live, but I understand the futility of my medical condition, and I don't want you to make rescue efforts to save me if I stop breathing or if my heart stops.  This means no chest compressions, no intubation, no rescue medicine if your heart stops, but other than that the doctor has many options available to keep you alive.

5.  Do Not Intubate (DNI):  Load me up with medicine, do chest compressions on me, but, by God, do not you dare put a tube in my throat so I can breathe.  The doctor can do everything possible to keep you alive except the one thing that will keep you alive  We have to pump $10,000 of medicine into you to keep you alive, but we can't keep you alive.  This is the option taken by patients improperly informed by their physician.

6.  Comfort Care Only:  Keep me pain free, help me breathe comfortably, but don't make rescue efforts to save me because I have a terminal medical condition.  Attempts to save me will just be prolonging my suffering, and I understand that. I prefer to pass on with grace and dignity.

7.  Cardiopulmonary Resuscitation (CPR):  If your heart stops we will make every effort to attempt to get you breathing, get your heart beating, and save your life.  This means we will do chest compressions, intubate you, and put you on a ventilator.  Despite contrary Hollywood myths, CPR has less than a 1% success rate.  You will not walk away from a CPR session smiling.  Medical professionals must do this unless we have a DNR order.

8.  Chest compressions:  One part of CPR where medical professionals will thump on your chest in order to circulate blood through your body.  This is now believed to be the most important part of CPR (for adults anyway).  Outside the hospital this is the only part of CPR that is recommended.  Chest compressions are now believed to both circulate blood and cause negative pressure to simulate breathing, making mouth to mouth breathing unnecessary. Plus people are more likely to do CPR when they don't have to do mouth to mouth. 

9.  Mouth to mouth breathing:  This is where you put your mouth over another person's mouth to breathe for that person.  You can use a barrier to keep your mouth clean.  And despite myths, rarely do people catch diseases this way.  While there is 21% oxygen in the air, the oxygen you exhale is more like 14%.  So such efforts are now deemed to be useless.  Likewise, studies show most people are hesitant to do  mouth to mouth breathing, and are more likely to do CPR if they just do chest compressions.  Yet old doctors who sit on the Basic Life Support boards are reluctant to change anything regardless of the facts. 

10.  False Heroism:  Saving a life when you know that person will be dead within a month no matter what.

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