Sunday, March 15, 2015

Coercion of DNRs

This post is similar to what happened to me under the Vancouver Health Authority.  I learned one thing from this post that the proxy should always be with the patient when DNRs are discussed. From web site True Dignity Vermont.


The Horrifying Medical Culture into Which the Vermont Legislature Has Injected Assisted Suicide


Over its years of fighting assisted suicide, True Dignity has become acutely aware that medical care of people with disabilities is fraught with discrimination: there is a dangerous assumption, on the part of able- bodied people with power, that certain types of life are not worth living and should be brought to a quick end.  Bill Peace’s article about his hospital experience (available on request by emailing admin@truedignityvt.org and also at a link posted March 10, 2015 on our Facebook page) and Lynne Vitzthum’s recent testimony about her pediatrician’s urging her to decline treatment for her disabled son are examples of discriminatory, arrogant and coercive medical attitudes and practices.  Peace and Vitzthum describe a medical and society-wide culture into which it is obviously deadly to introduce assisted suicide.

True Dignity has received yet another compelling personal account of this dangerous and coercive medical culture and the devastation it wreaked on the lives of VT patients and their families even before assisted suicide became legal.  One has to set reason aside to ignore the reality that the very same powerful people who act coercively with regard to what their prejudice causes them to define as “overtreatment” of people with disability, the old, and those thought to be terminally ill, will act coercively with regard to assisted suicide.

The events described in this story took place at a hospital and rehab/nursing Home in Vermont.  As much as we can without revealing identifying information, we will let the person involved, who was the designated surrogate for her partner, tell the story in her own words, which are italicized and indented.  For the partner’s protection, and ours, we are calling the patient, “John Doe”.  We have not changed the partner’s capitalization and boldface of words and phrases she wants to emphasize.

For several weeks I was there (in the hospital) as the legal Health Care Proxy and Life Partner of (Mr. John Doe), aged 79.  He was to have outpatient Cancer treatment which turned into hospital care.
early in treatment the Oncologist appointed to Mr. Doe started him on chemotherapy and diuretics for swollen ankles of unknown cause… There was no warning that chemotherapy by itself could cause infections.

(Mr. Doe) was admitted to the Hospital with a Pneumonia type lung infection which got steadily worse each day. The Oncologist did not see (Mr. Doe) during this crucial time.  Out of a large team of changing Doctors and Residents we mostly saw one Resident that week who basically said nothing could be done for the infection… When asked what could be done for his pain the Resident glibly replied,”Research has shown that Marijuana is good for pain.” Useless information at the time.

Shortly after (Mr. Doe) was transferred to the Intensive Care Unit. The Oncologist, knowing that I was the Health Proxy, went behind my back trying to pressure my Partner into signing a “Do Not Resuscitate” form. My partner was distressed when he told me the Doctor and a Resident had approached him with a form he did not want. He wanted to live!

On (the next day) I walked in on the determined Oncologist with a Resident again, for the second time, trying to pressure (Mr. Doe) into signing a DNR.  I showed my legal papers that day. The doctor used Residents supposedly as Witnesses for the Patient.

Doctors should not be allowed to pressure or intimidate Patients into choosing death without the presence of the Patient’s family or designated Proxy…

On (the same day) late afternoon two young people either Doctors or Residents said my Partner would need Ventilator Life Support for his critical lung infection. They strongly advised against the ventilator saying, “Most people wouldn’t choose that. He only has a 50-50 chance of survival.” To me letting the Love of My Life die with a good 50-50 chance at life would be MURDER.  I chose the ventilator against their ‘Whatever’ attitude of disdain.

On (the next day) an especially nasty light haired Nurse, who had angrily confronted my Ventilator decision the day before, barked when I asked his condition.  “He’s only alive because WE’RE keeping him alive, His numbers are good because WE’RE making them good!”  Yikes, I had the stupid idea that Hospitals are supposed to save lives. Yes, there may come a time for the patient and family to decline treatment but not by being bullied to death.

(Two days later) after a Pulmonary Doctor told me the Patient was showing improvement the Oncologist showed up with the usual foreboding of doom, got within inches of my face and arrogantly berated me with eyes blazing, “I’ve had patients come off the ventilator and tell their families “DON’T YOU EVER DO THAT TO ME AGAIN!” A nasty unprofessional encounter. I had to inform the hostile Doctor that I knew of John Doe’s wishes FORTY YEARS LONGER than his five minute visit.

(The next day) a patronizing brunette Nurse gave me a speech on how “Nurses are patient advocates” as though I were his enemy. She mouthed a righteous pitch on “Death with Dignity” then proclaimed, “(Mr. Doe) feels that he has lost his right of choice.”  With his eyes closed and a Ventilator tube down his throat (Mr. Doe) couldn’t speak but she wisely knew of his wish to die.

In fact my decision was right and the GODS were wrong. The week after Life Support (Mr. Doe) was feeling, eating and looking well. Not one Death Advocate had a glad word to say about his recovery. He was released to a rehab center to rebuild strength for further cancer treatment. He was discharged to the rehab on high doses of prescribed blood thinners with no hospital oversight. 

Three days later the patient was sent from the rehab facility in pain from exercise back to the same hospital’s emergency room where internal hemorrhaging due to blood thinners was misdiagnosed as sciatica back pain. He was released back to the rehab. He continued to be in severe pain but the rehab doctor on call would not come over the weekend. He sent his Nurse on Monday. She sent (Mr. Doe) back to the hospital in near death condition. It had taken much begging before the Rehab even called the doctor.

It turns out that the doctor on call had no legal obligation to see the patient. By the time (Mr. Doe} was finally readmitted to the hospital and the hemorrhaging diagnosed and treated, it was too late. After blood transfusions he did not recover well enough for further cancer treatment and was sent home to die.
The hospital later admitted the misdiagnosis, in writing, but claimed it was due to the patient’s atypical symptoms. The hospital was still cited by the State Division of Licensing because a Physician Assistant, PA, made the incorrect diagnosis of sciatica without consulting a Doctor. Here is more from the Patient’s Partner:

(Little more than a week later) upon leaving (the hospital) to go back to our town to die I got my last scolding from one of the last team Doctors saying more than once, “You’re the ONE who’s keeping him Alive, we often have this PROBLEM with Couples.”  Love is now a problem. 

…Never before had I imagined being in a Hospital that wants the Patient to DIE.  From this awful experience I believe that with legal ASSISTED SUICIDE those patients who want to die will be outnumbered by those Elderly who are forced to die. DEATH IS GUARANTEED TO ALL without Assistance. In my view it is more important to protect the RIGHT TO LIVE than the Right to Die.

(Mr. Doe) remained in constant pain with no use of his legs since the two days of  misdiagnosed, untreated hemorrhaging. He died 11 days after leaving the hospital. This happened in 2010.
Whatever you think about aggressive care at the end of life, surely doctors should not be prejudiced enough to try to destroy the autonomy of a patient who, during some of these events, was able to communicate his dismay at being pressured. Surely he should have never been pressured in the absence of his life partner and proxy, especially by two doctors, one of whom was dependent on her superior and scarcely could be expected to countermand him.

Shockingly, such behavior is not actually illegal in Vermont.  In fact, the physician did not even have to consult the patient or proxy.  All he was legally required to do was recruit another clinician (the resident?!)  to join with him in defining resuscitation as futile care by issuing “a certification…that resuscitation would not prevent the imminent death of the patient, should the patient experience cardiac arrest (http://healthvermont.gov/regs/ad/dnr_colst_instructions.pdf).   This man lived six weeks more after a Pneumonia type infection so using “imminent” to describe his death does not seem to be justified. This doctor clearly had a point of view that he was determined to impose, and he did not conceal his anger when someone bucked his authority.

The only thing that kept this patient alive after Pneumonia was the strength of will of his partner, who did not care what people in the hospital thought about her, even as, she writes, “Between the Death Advocates at the Hospital and the indifference at the Rehab Center, I DID START TO QUESTION MY OWN AND ALL SANITY.”  When everyone else is for death, it’s hard to stand firm on a choice for life, but she did it, admirably.

The real agenda of the promoters of assisted suicide has nothing to do with the “choice” which their promotional ads tell us must be honored at all costs.  It is about getting rid of people who need care that is costly and time consuming.   “At all costs” is an apt phrase, because patients, who, as this story shows, are already paying the costs that hospitals and the states are cutting everywhere, will lose more and more of their liberties if assisted suicide becomes an ordinary part of end of life care in Vermont.








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