When an employee of Glenwood Gardens in Bakersfield, California refused a dispatcher’s request to initiate CPR on an 87 year old woman who had collapsed, it made national news. While I do not know enough facts of the situation to judge if the employee did the “right” thing, it is a good opportunity for older people, their families, and retirement/care facilities to discuss how similar situations should be handled in the future.
Something I have not heard in the reports of this incident is that CPR is a medical treatment, and as with other medical treatments it has potential risks and complications. It is not unusual for ribs to be cracked or broken when preforming CPR. In some cases a broken rib can even puncture a lung. Also if there is not good profusion of blood during CPR the person receiving CPR may suffer brain damage from lack of oxygen to the brain. On the other side, if CPR is not performed on someone with a cardiac or pulmonary arrest they will almost certainly die. The stakes are huge!
I have talked with enough older people over the years to know that some healthy seniors do not want CPR if they have an unexpected cardiac or pulmonary arrest; they generally express thoughts along the line of: “I’ve had a good, long life.” “I am ready to go.” I do not want to risk having to live in a vegetative state due to brain damage.” Other seniors would want CPR; they generally express thought such as: “I’m not ready to give up on life.” “I want all the time I can have with my family and friends.” “The benefits of successful CPR outweigh the potential risks.” Current thought and practice is that competent adults have the right to accept, limit, or refuse medical treatment (in some states there are exceptions for women who are pregnant). A problem occurs when that person in need of treatment is unconscious and cannot express his or her wishes. Since death cannot be undone, the presumption made in these situations is the individual would want life preserved. This puts the responsibility on those who would not want CPR do use every available means to let others know their wishes.
Many people express a Do Not Resuscitate (DNR) desire in a Living Will, however, a Living Will only applies after a physician has made a determination that the person is either terminally ill or is in a permanent state of unconsciousness. Some people express these wishes in a POLST (Pennsylvania Orders for Life Sustaining Treatment) form, but these are generally used only for those people approaching the end of life. The PA Department of Health has a n Out of Hospital Do-Not-Resuscitate Order form; these are only available through a health care provider, and I have only seen them used in end of life/terminal illness situations, If a person is in a medical care facility, he or she can request the attending physician to write an appropriate DNR order in the medical record. Consequently, if you are entering some type of a care facility and do not want CPR, be sure to check if they are able to honor those wishes and what needs to be done in the way of orders/paperwork to honor these wishes. It is also very important to discuss these wishes with your healthcare POA or family, if you have no healthcare POA, since these are the people healthcare professionals look to for guidance and decisions when you are unable to communicate your own wishes. Conversely, if you do want CPR, it is wise to let your healthcare POA/family/ physician know this as well.