Dear Carol: My family is having a disagreement over signing do not resuscitate (DNR) forms for our mom who has just entered a nursing home. I have power of attorney. She is going into the nursing home for both physical reasons and mid-stage dementia. My siblings think that everything should be done to keep Mom alive as long as possible, but Mom's POA states that she doesn't want to be kept alive beyond what common sense would dictate.

Admittedly that is vague, but when she's lucid she agrees with what she wrote in her POA for health care even though she probably would not now be considered competent to sign papers.

I can push through the DNR, but I feel sad because my siblings are upset. I know that they don't want to see Mom suffer unnecessarily but I think that they feel guilty taking this formal step. How do I get through to them that there's a point where nature should take over?-CD

Dear CD: My condolences to you and your family as you go through a confusing and difficult situation. I've been in your shoes several times, and it's never easy. Fortunately, you know what your mom wants, which is an enormous help, and I think that your siblings will come around.

They need to understand that while signing DNR forms seems terribly final she could still live for years. These forms are necessary because nursing homes don't want to make a terrible mistake by medically stopping the natural death of someone who is in the final stages of life simply to extend their pain and misery. Without the proper documentation this is what they could be forced to do.

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If your siblings can understand that without this documentation your mother could be sent to a hospital and even face surgery when it would only extend her misery and not her life, they may find that accepting the formal DNR isn't so terrible. Getting that concept through to them is your challenge.

In his book, "Wishes to Die For," Dr. Kevin Hasselhorst says that he prefers the phrase "allow natural death" to "do not resuscitate." Likely this term is suggested elsewhere, but the first time I saw this reference was in "Wishes," and I was drawn to its simplicity and compassion.

As a family member, I would find it less unpleasant to sign a form that said to allow natural death than the negative do not resuscitate. I don't believe I'm alone in that and would love to see this wording used. Explaining this concept to your siblings may help a little even though for now we are stuck with the term DNR.

I want to be clear that DNRs are generally only invoked when people are at a stage where little or no quality of life can be expected if the person is revived. This is often the case for people who have advancing dementia or other agonizing and unrelenting ailments that have placed them in a hospital or nursing home. It's a way of acknowledging the fact that everyone will eventually die and that just because we can artificially keep someone breathing another day or another week doesn't always mean that we should.

I'd suggest that you and your siblings together seek a consultation with the chaplain at the nursing home. Your siblings may also want to talk with their own spiritual leader. The social worker at the nursing home can be one more resource to smooth out the uneasiness of the situation.

You are right to want to follow your mother's wishes. You are also right to want to help your siblings understand. With help, I believe that you can do both.

 

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting seniors and caregivers at www.mindingourelders.com. She can be reached at carolbursack@msn.com.