Living wills, IMO are not worth the paper they are printed on.  I have had several pt's over the years, that have had living wills, and their family have over ridden their requests once the pt has beame unresponsive. I know in several of these cases, CPR was done on the pt's.  However,  It's been a rare case that I have seen a DNR go to the ICU.  As long as we allow family members to make the decisions for pt's it's going to happen.  Why, again I was told by one doctor that family members can sue, because they will be here and alive after the pt is gone. 

When I worked in Florida, we had a 90 something pt, with a living will who was also terminal.  Her relative who was a bigwig lawyer and politician in the Florida legislature came in, and said now that she was unresponsive, we would remove the DNR status because he as her NOK, was in charge.  We did so, and did CPR on her.

In my 15 years in ICU there have been many many many that the docs or the family kept alive way past all reason or humanity.  Those are the ones we see in ICU , what about the ones who go home or to the nursing home and are kept on vents or parenteral nutrition etc.  Little or no oversight.  The ICU patients that are kept for week or months are a crime.  If we did this to prisoners it would be torture--force feeding, made to lie in your own waste, no music no TV or constant noise and constant tv.  Painful contractures and bed sores and impactions and needles etc.  How many good nurses are there who do full ROM exercises every 2-3 hours, back rubs, monitor all pressure points closely heels, the back of the head, buttocks, ear and elbows?  How many find out what music the person enjoyed and get that to be played in the room.  How many orient them to what is going on in the world everyday and talk to them about family etc.  How many make sure the head of the bed is up sufficiently for a good cough when you suction instead of suctioning the poor SOB flat on their back hour after hour"?  I have a lot of pet peeves when it comes to caring for an ICU patient.  How many approach the family and tell them how hard it is to be the person in the bed with all this being or not being done to them?  That they are suffering.  I think families who decide to do everything and keep MOM alive need to pick one of the brothers or sisters and lie them in a ICU room for 24 hours.  We do not stick them more than once but subject them to noise, and turning and sleep cycle disruption and too much or too little fluids and peeing and deficating in bed and relying on others for everything. Lots of machines in the room making noise and people talking over you about things you have no idea of what they mean.  Tie them down with restraints see what that feels like, don't listen to them when they talk because an intubated person can't talk.

After that let them tell us it is worth it to do everything because they don't have the guts to face death for their relative and let them go.

If you don't want to be kept alive, the best thing you can do is a healthcare power of attorney, with someone that you know will respect your wishes.  

I have durable power of attorney, and healthcare power of attorney for both my parents.  My 93 yo father had a stroke 2 weeks ago, and we kept him home.  We brought him to my house, honestly, Mom and I were prepared that he just might pass.  He has A.D, PTSD, dementia, prostate CA, and a list of others too long to list.  He has recovered enough, that he is actually up and able to walk a short distance, and sit up and watch tv.  I take him to his PCP, who has been wonderful enough to send in a visiting nurse, and a HHA 3 Xs a week.  IT's been a tremendous help.  I don't know what the future holds for him.  I plan on keeping him home as long as we can.  He's here tonight, because it's too much for my 84 yo mother to handle. 

Part of the problem, as was also featured in this piece, is the denial of the pt and the family. There was another pt who had lung and liver disease, and when asked by the Doc what he wanted, he chose CPR. I was familiarly horrified. Why are pt's not being educated to death and dying and dying with dignity? What is wrong with these people? I blame lack of knowledge and education.

I also blame the medical field for not properly informing pt's of their outcomes and choices.I had a terminal pt who was told he only a day or so to live. What did his Doc do? He admitted him as a DNR and then proceeded to order unnecessary tests while this man was actively dying! I encouraged and convinced the pt and his family to go home with hospice. Unfortunately , the pt died before he was d/c'd. How sad. This pt and his family were deprived of a peaceful dignified death at home surrounded by his loved ones.

I could go on and on. I had a pt with MS and multiple decubs. with PEG, Trach(on Vent), and no quality of life. The ethics committe treid to convince her spouse to make her a DNR. You know what he did? He made her a "chemical code". Again, denial can be a strong deterent whan it comes to dying a peaceful death. It is these cases that make me realize that a change is needed. But, not the govt's idea.

I think death and dying should be a required field for MD's. End of life issues should be a mandatory course. Many MD's, out of fear of litigation , and the superman syndrome simply cannot accept that a py may die. It's a natural part of life. I don't get it.

Part of the problem, as was also featured in this piece, is the denial of the pt and the family. There was another pt who had lung and liver disease, and when asked by the Doc what he wanted, he chose CPR. I was familiarly horrified. Why are pt's not being educated to death and dying and dying with dignity? What is wrong with these people? I blame lack of knowledge and education.

I also blame the medical field for not properly informing pt's of their outcomes and choices.I had a terminal pt who was told he only a day or so to live. What did his Doc do? He admitted him as a DNR and then proceeded to order unnecessary tests while this man was actively dying! I encouraged and convinced the pt and his family to go home with hospice. Unfortunately , the pt died before he was d/c'd. How sad. This pt and his family were deprived of a peaceful dignified death at home surrounded by his loved ones.

I could go on and on. I had a pt with MS and multiple decubs. with PEG, Trach(on Vent), and no quality of life. The ethics committe treid to convince her spouse to make her a DNR. You know what he did? He made her a "chemical code". Again, denial can be a strong deterent whan it comes to dying a peaceful death. It is these cases that make me realize that a change is needed. But, not the govt's idea.

I think death and dying should be a required field for MD's. End of life issues should be a mandatory course. Many MD's, out of fear of litigation , and the superman syndrome simply cannot accept that a py may die. It's a natural part of life. I don't get it.

Mr Brown thanks for the words of encouragement. 

The problem for most lay people, is that they need to talk about these decisions before it happens.  I know for us, we knew that it was just a matter of time before something happened to my Dad.   We had already made the decision no more tests, no hospitalizations,unless he was in pain.  As nurses we face death every day, and its something we think about.

Exactly which is why my children have had the documents and the conversation with family about what they want at end of life since they were 19.  See they are my stepkids and their Mom wold insist on everything being done in a very unrealistic manner.  Since hish school and college age prople are the most likely to get into accidents they thought they should be covered so their Mom couldn't swoop in and overrule their wishes at least they would have done all they could do and their dad and I could get the lawyer to fight for their rights.  As you know accidents, aneurysms, heart conditions, etc can happen to someone of any age.  I just think we should mandate the insurance companies to require the yearly review of end of life documentation.  I don't think it is very helpful to wave a paper under the nose of a patient at admission and say sign here so we will follow your wishes.

Education in high school and college with provision of the paperwork is a great start.  This will also help younger adults to understand their parents wishes when they have to make the decisions.  My mom died at home with me as the primary caregiver, I was 19 and in college.  My cousin who was a nurse came and helped out the last 3 weeks of her life.  Difficult sure but I know I did the best I could do to honor her wishes and have her die peacefully at home.  Oh yeah this was before Hospice in Colorado so no home healthwas there.