A lot of hurdles to jump: Do Not Resuscitate Orders

A story by healthcare blogger Patricia Walling:

A man I knew wrote a Do Not Resuscitate ["DNR"] order in his 80s, before a hip replacement. That's a form you can fill out with a physician's signature to ensure that you are not resuscitated against your will after your heart or breathing stops. In the order, he included a lot of hurdles to jump before the plug could be pulled.

Years later, when his physical and mental health began to deteriorate rapidly in his early 90s, things became chaotic and stressful both for him and his children. At that point, he was dying of prostate cancer and just wanted them to let him die. Unfortunately, he had neglected the critical step of reviewing the DNR order every five years. The DNR order he had written in his 80s did not address many of the issues that became critically important in the final months of his life.

Recently a movement has begun to rename these forms "AND" (Allowing Natural Death) to emphasize through medical coding that the doctor is allowing death, rather than withholding care somehow. Having a DNR can be handy if you have been suffering from a disease for a long time, want to avoid the violence of CPR at death (which can often break ribs and other bones, especially in the elderly), or just want to be allowed to die at home rather than in a hospital. Numerous studies have found that end of life care tends to be prolonged needlessly, inflicting pain on the patient and imposing financial and emotional burdens on both patient and family, and a DNR/AND can help to alleviate those issues.

Patricia Walling's advice: Make sure to review it in detail with your doctor, appoint someone as a health care proxy, and don't forget that sometimes your wishes may change.

He needed surgery again: A settlement for a defective artificial hip gets justice for one, but no registry for all

Months after his hip replacement, "the pain was grabbing me around the back," said Stephen Csengeri, a 54-year-old lawyer from California. He needed surgery again because of the pain. He has reached an undisclosed settlement with Zimmer Holdings, the maker of his metal hip socket.

His orthopedic surgeon, Dr. Lawrence Dorr, realized that Stephen was one of many hip replacement patients with the same problem. Dr. Dorr contacted the device's manufacturer. X-rays showed the socket was separating from bone, rather than fusing with it. For patients, who had been told their new hips might last 15 to 20 years, it meant agony as the metal cup moved around in the hip socket and rubbed against bone.

One doctor told Dr. Dorr, "If ever there was an example of why we need a registry [recording all patients’ hip appliances], this is it." A registry is a database of each patient, the brand, model and type of appliance implanted, the surgical technique used, the doctor, and any subsequent replacement. Orthopedists in Sweden and Australia have used such registries to learn of systematic problems with particular devices. But there is no registry in the U.S. As a result, there is no systematic way for the public to know of patterns of problems.

Advice to joint replacement patients: Look into the devices beforehand on domestic and foreign registries and on the Internet.

Read another medical device lawsuit story.

Thanks to Barry Meier for the source story in today's New York Times.