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Post by achot on Jun 4, 2009 3:55:16 GMT -5
Is it going too far (halachically speaking) to allow CPR to be done on a patient who is DNR (with a Rabbi's blessing and POA's signature) due to a terminal illness and old age (93) simply because the staff needs practice....?
Yesterday a pt finally went to her Olam (was niftar) at 7pm in our nsg home, she suffered a terminal illness and had gangrene in a few parts of her 93 yr old, 44lb body. The family had signed DNR which is legal now in this situation in Israel (called Chok Steinberg).
Because we didn't have a doctor in the house at that hour, we called MDA and explained the situation. They sent two teams to do CPR, NEbach, they put the body on the floor, crushed ribs in their feeble efforts to revive her half an hour after we found her without pulse/respirations.
I objected and pulled out the DNR letter and had to call their supervisor till they finally stopped.
She was buried with crushed bones and marks all over her body thanks to their efforts.
I was told afterwards that this is done in order to give new staff opportunities to practice CPR on a real body,...
What do you think?
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Post by medic09 on Jun 4, 2009 8:53:52 GMT -5
My first thought is that there may be several prohibitions involved here; all considered very serious.
Bizuy Hamet involves anything that demeans or embarrasses the deceased without real need.
Another issue involves the halachic obligation to carry out the known wishes of the deceased.
There is also a prohibition of hanaah min hamet, benefitting from the dead. This is the reason often given for not doing autopsies out of curiosity, or using Jewish bodies for cadaver labs in school.
I can think of no reason to allow CPR or any other actions on the deceased, if they are DNR, and those actions fit under that heading! According to our tradition, the soul is present and knows everything done to the body (or not) right up through the burial. Heaven help us for the anguish we cause some people at their deaths!
We had a related incident shortly after I came to NM. I work occasionally as a paramedic in rural counties. It is common that by the time we arrive at some far off ranch or farm for a cardiac or respiratory arrest (sometimes with CPR in progress by family), there isn't really any reason to work the code, and we call it pretty quickly on scene. We had such a code, where we established death shortly after arriving, without intubating or drugs, etc. I was precepting a new paramedic at the time.
On the way back from the scene, the EMT driving said we'll go to the county coroner. Why? So that the new paramedic could intubate the newly deceased for practice. I told them in no uncertain terms that I was the boss in that ambulance, and there is no way no how that any crew of mine was going to practice anything on a deceased patient. We get our practice in the process of patient care or attempted care, or in controlled labs where the cadavers donated themselves. We do NOT ever practice on a deceased person on scene.
They were shocked. They told me it was often done that way. I stood my ground that even IF that were legal (I think not in our case, since we had left the scene), it were flatly cruel and immoral in my understanding, and will not be done ever in my ambulance.
I think you ought to speak with your facilitiy's rav and have him clarify this. I also think that your DON/CNO should file a letter of protest with MDA over their gross mistake, assuming that they were really knowingly ignoring a DNR. It could be, btw, that the answer they gave about 'practice' wasn't sincere, and that they said it to somehow make it right and cover up their embarrassment.
I'm very sorry your patient and family had to suffer this indignity.
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Post by achot on Jun 4, 2009 23:55:27 GMT -5
Our Social Worker has already penned a letter to MaDa, we know there will be backlash, unfortunately even my DON says its ok for them to have practiced on her..."How did you and I learn, its for the ultimate good" and I cant argue with her, but the SW agrees with me, BTW I was officially off duty when MaDa came I was at the end of a double shift when the new nurse called to say that the pt died, I went to show her how to deal with this, starting with putting out the Azhara LaKohanim sign ( the russian shomer couldnt find it and so we put up our own hand written one). I am glad I had stayed as she hadn't noticed the DNR papers in the chart.
We decided not to tell the dtr as that will just cause her much anguish.
Thank you for your response
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Post by Rivka P on Jun 6, 2009 22:03:41 GMT -5
achot, did you learn CPR on a decease person? because I learned on a dummy.
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Post by achot on Jun 7, 2009 2:06:38 GMT -5
first time on the ever famous Annie...back in 1983....then I took refresher courses over the years and poor Annie is now limbless- just a head and torso...so we called her An.
But I have done it on many people who needed it over the years. I never PRACTICED on a deceased body...although it is always done on a person whose pulse and respiration have ceased...
Sometimes it was even successful!!!(B_H-m)
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Post by Rivka P on Jun 7, 2009 16:34:00 GMT -5
wow. I have never yet performed CPR and had the person live. That's gotta be amazing!
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Post by achot on Jun 10, 2009 13:09:24 GMT -5
I am a bit older than you so have had more years in the system...heres to hoping you never need to do it....although most of the time CPR is performed it is unsuccessful. We have a defibrillator in-house and two years ago I trained my staff to use it, but they are timid and still call MDA right away and do CPR till MDA comes (usually within minutes) and they bring their own equipment.
It IS amazing when CPR works. ... although in the nursing home it is usually just "buying time" I have had the zechut of seeing a little girl regain her respiration and pulse - but we started it right away and in a few minutes the pulse returned, Regardless of success it makes a statement of how we value life...uvachartem bachayim ....Everyday that a person lives and is able to say "Baruch Hashem" I feel has value for we say "Lo Hamaytim Yehalelukah"
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Post by Rivka P on Jun 11, 2009 1:26:51 GMT -5
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Post by achot on Jun 11, 2009 5:33:18 GMT -5
Thanks so much for the link, my nurses dont read a good english, (hebrew and some russian) but I am sure I can find it in hebrew as well if I wanted.
I have discovered that if a nurse is timid about something like a defribrillator ( I am not talking about a sphygmomanometer here) I should wait for them to feel comfortable an I am OK with them calling MDA and waiting the few minutes while doing proper CPR. If I push and something goes wrong it could be worse.
The machines use is quite simple, anyone can do it, so I know the problem is just habit. I pick my battles and right now that is not up there. After the Chagim I will organize another course and ask for another demonstration and explanation.
So much to teach, so little time...sigh
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Post by medic09 on Jul 2, 2009 22:45:55 GMT -5
T So much to teach, so little time...sigh One night (today Rav) Shmuel Strauss and I were walking home through Geulah in Yerushalayim, and he gave me a good insight to the mishnah in Avot - Lo Alecha Ham'lacah ligmor... It isn't up to you to finish the task, nor are you free to desist. Sammy said that means that Hashem gives us all the time and means we need to accomplish what He requires of us in this world. We don't have to see it, and often don't know what the tasks are. We just have to continue the labor each day with a complete faith that we have all the means and time we need. Keep up the good work!  |
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Post by achot on Jul 3, 2009 0:22:53 GMT -5
:-)
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