You may have heard the rather unfortunate story of Lorraine Bayless and the Glenwood Gardens nursing home.
Spoiler alert: Lorraine fell into cardiac arrest and the facility declined to administer CPR, despite the pleading 911 operator. Why? “Company policy.”
This matter has been taken up by Forbes in two recent articles, by two different authors. The first, by Howard Gleckman, is titled “The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn.” The second Forbes article is penned by Carolyn Rosenblatt and is titled “Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?”
Here are four key facts. First, Lorraine was having a stroke and CPR was not likely to help her. Second, the “nursing facility” was actually an independent living facility without skilled nurses. Third, Lorraine herself had not wanted a long drawn out passing; and fourth, Lorraine and her family already had arranged for a Do Not Resuscitate (DNR) order.
Against this backdrop, each of us needs to know two fundamental wishes when it comes to our loved ones:
1) What does your loved one want and need in a facility? Since the facility in question was not an actual nursing home and the “nurse” was not actually a skilled nurse, the staff was not allowed to perform CPR, both by “company policy” and by law. There are many types of facilities that offer varying degrees of medical or personal care. Someone placed in the “wrong” facility may mean not have his or her wishes concerning end-of-life care honored.
2) Likewise, what does your loved one want (or not want) when it comes to end-of-life measures? What decisions has your loved one made regarding emergency care, resuscitation, or life-sustaining apparatuses (such as ventilators)? Lorraine purposefully had a DNR order on file, had made her decisions regarding end-of-life measures, and her family clearly knew her wishes. Nevertheless, there are many additional considerations when it comes to making and communicating your wishes.
As you might imagine, it’s best for your loved ones to commit their wishes and decisions to writing. The most common form is known by many different names, but is simply a written record of their healthcare directives made in advance. As with financial matters, your loved ones also will want to sign durable powers of attorney for medical matters and appoint the “agents” they know and trust to carry out their wishes. The power of attorney for health care and directive for end-of-life care can be wrapped up in one document.
Another document to consider for someone who is unlikely to recover from attempted resuscitation is the Physician’s Order for Life Sustaining Treatment (POLST), sometimes called Medical Orders for Life Sustaining Treatment (MOLST). In this document, a person can set out just how far he or she wants paramedics to go in resuscitation efforts. A person may wish for all efforts to be made to keep him or her alive, or the person may simply want to be kept as comfortable as possible with no attempt at resuscitation. The point is to spell out your wishes in writing.
Regardless, the object of these kinds of documents is to empower your loved ones to inform their loved ones, doctors, and medical facilities about their wishes now so those wishes can (and will) be carried out later. As these end-of-life wishes can generate heightened emotions, it is best if everyone concerned is informed rather than surprised.
End-of-life planning isn’t just for "old folks." Any one who has attained the age of majority should consider his or her end-of-life wishes. The famous cases that have defined this area (Quinlan, Cruzan, Schiavo) involved young women. Don't let your kids go off to college or deployment or a European vacation without signing an advance health-care directive. Have you made your wishes known through proper documentation? The best way to encourage personal responsibility in others is to lead by example.