Is Refusing All Medical Care A Rational Choice For End-Of-Life Planning?

[Slask]

I am not suicidal. But I am in my 70s and I am trying to make plans and policies appropriate for my age, dealing with end of life. I'm doing this while I'm still healthy.

I wear a Medic Alert ID Tag that says "Refuse all Medical Care" PF is visited by civil intelligent people so I would like some validation of my reasoning.

I live an active and very happy life style, even at my advanced age. My worst nightmare is that I will become an invalid (or worse) and suffer a lingering death. I believe that is a mainstream hope that nearly everyone shares. Most medical events are out of my control. I may be lucky and have a swift death, or not.

However, I think of the possibility of an accident. I use the metaphor of being run over by a bus. If that happens to me, and if my injuries are so severe that I can not communicate with the first responders, then I believe that the probability of death is high if I receive no treatment. I also believe that the probability of becoming an invalid if I survive with treatment is very high. In other words, if I do get run over by a bus, my hope for a swift death is nearly achieved, but it could be transformed into my worst nightmare by a hospital. Hence, the "Refuse All Medical Care" tag.

On the other hand, if I get run over by a bus, but I am able to communicate with first responders, then I can ignore the tag and make up my mind whether or not I want treatment.

In other words, I consider that tag to be an enhanced DNR (do not resuscitate) order,

I have three questions:

1. Is my logic valid?
2. Do state laws allow first responders to respect my request and to leave me to die on the side of the road?(When I sat it that way, I suspect that the answer is no.)
3. Is there a better way to manage this risk other than a Medic Alert ID tag?

 

[berkeman]

I am not suicidal. But I am in my 70s and I am trying to make plans and policies appropriate for my age, dealing with end of life. I'm doing this while I'm still healthy.

I wear a Medic Alert ID Tag that says "Refuse all Medical Care" PF is visited by civil intelligent people so I would like some validation of my reasoning.

I live an active and very happy life style, even at my advanced age. My worst nightmare is that I will become an invalid (or worse) and suffer a lingering death. I believe that is a mainstream hope that nearly everyone shares. Most medical events are out of my control. I may be lucky and have a swift death, or not.

However, I think of the possibility of an accident. I use the metaphor of being run over by a bus. If that happens to me, and if my injuries are so severe that I can not communicate with the first responders, then I believe that the probability of death is high if I receive no treatment. I also believe that the probability of becoming an invalid if I survive with treatment is very high. In other words, if I do get run over by a bus, my hope for a swift death is nearly achieved, but it could be transformed into my worst nightmare by a hospital. Hence, the "Refuse All Medical Care" tag.

On the other hand, if I get run over by a bus, but I am able to communicate with first responders, then I can ignore the tag and make up my mind whether or not I want treatment.

In other words, I consider that tag to be an enhanced DNR (do not resuscitate) order,

I have three questions:

1. Is my logic valid?
2. Do state laws allow first responders to respect my request and to leave me to die on the side of the road?(When I sat it that way, I suspect that the answer is no.)
3. Is there a better way to manage this risk other than a Medic Alert ID tag?

Welcome to the PF.

Have you discussed this with your doctor? Where did you get the bracelet?

DNR rules and laws vary by state and county, so it's important for you to discuss the options with your doctor, and get any necessary forms signed by your doctor.

 

[gleem]

It is my understanding that a valid legal DNR document (Living Will) must exist to support any other evidence as a bracelet or tattoo that resuscitation is not to be performed. If you go into cardiac arrest, or you are unconscious and bleeding profusely, both of which if treated would return you to your previous lifestyle would you still not wish to be saved? Also if you have a stroke which leaves you in a coma, you seem to fear, your bracelet will not help. Thus you should entrust the medical intervention decision to someone that will respect your wishes by having a legal Living Will drawn up. I don't think EMT's are there to to make any decisions except how to keep you alive until a physician can evaluate you.

I share your concern but the DNR request only makes sense to me after a physician has evaluated your condition and determines that further medical intervention is not beneficial.

 

[Slask]

Have you discussed this with your doctor? Where did you get the bracelet?

DNR rules and laws vary by state and county, so it's important for you to discuss the options with your doctor, and get any necessary forms signed by your doctor.

I share your concern but the DNR request only makes sense to me after a physician has evaluated your condition and determines that further medical intervention is not beneficial.

Thank you for your replies. I'm extremely jealous over my exclusive authority to manage my own life. I am not willing to share that authority with anyone, not even doctors.

gleem touched the heart of the problem. I retain the sole exclusive right to judge what is "beneficial" regarding my own life. That should not be controversial considering that doctors have a financial interest in providing more treatment. They are never neutral parties.

Also if you have a stroke which leaves you in a coma, you seem to fear, your bracelet will not help. Thus you should entrust the medical intervention decision to someone that will respect your wishes by having a legal Living Will drawn up.

I must admit gleem your logic seems sound, and it challenges my logic. Thank you.

 

[berkeman]

Thank you for your replies. I'm extremely jealous over my exclusive authority to manage my own life. I am not willing to share that authority with anyone, not even doctors.

Well, you still need a doctor to sign your DNR, or it is not legal in most places that I'm familiar with. In the county where I'm licensed as an EMT, you need the form completed before you can get the legally-recongized medallion or bracelet. If you don't have the form with you or the legally-recognized medallion, you will be treated and resuscitated, period.

You absolutely as a responsible adult get to make these decisions, but you need to get the legal stuff right if you really want to make sure that the DNR is binding.

 

[russ_watters]

Well, you still need a doctor to sign your DNR, or it is not legal in most places that I'm familiar with. In the county where I'm licensed as an EMT, you need the form completed before you can get the legally-recongized medallion or bracelet. If you don't have the form with you or the legally-recognized medallion, you will be treated and resuscitated, period.

You absolutely as a responsible adult get to make these decisions, but you need to get the legal stuff right if you really want to make sure that the DNR is binding.

I'll say it another way: it is unfair to put anyone but a doctor in a position to make/take responsibility for that decision. I realize you think that bracelet (I assume it is not the legally recognized one berkeman is referring to) simplifies things, but somewhere, someone is going to have to read it, decide if it applies, then act based on it. Part of the reason a doctor gets paid those big bucks is they alone are allowed to sign your death warrant. So please don't put other people in that difficult position. Nothing an EMT can do will interfere with the decision anyway.

 

[Slask]

OK, I'm glad I posted. You guys gave a fresh perspective that I missed. Thank you.

 

[Evo]

Don't forget in an emergency situation, a bracelet can get lost, be sure as gleem pointed out that you have a living will, that there is someone with the power of attorney that knows your wishes and has that in writing and witnessed.

I am with you, my greatest fear is being a vegetable, forced to live a worthless life of nothing but pain. I feel that the right to die should be a federal law and not dependent on individual states. It isn't going to kill those that wish to live, but allows those that wish to die rather than suffer needlessly and painfully, and be a financial drain to their family allowed that right. I don't think it is right to be forced to live a life with no hope of improvement and only pain. I wouldn't wish that on my worst enemy.

 

[jobyts]

If you carry such a bracelet, please let your loved ones know about it. In case, you were ran over by a bus and died, and the family then came to know about the bracelet, they could intrepret that you actually committed suicide. This could bring enormous pain for the family.

 

[gleem]

If you carry such a bracelet, please let your loved ones know about it. In case, you were ran over by a bus and died, and the family then came to know about the bracelet, they could intrepret that you actually committed suicide. This could bring enormous pain for the family.

I bet the life insurance company ( if a policy exists) would try and push the suicide issue to void the policy.

 

[Slask]

I think I've gotten good advice here. Thanks all. But the advice will be hard to follow.

I have no insurance, and I haven't had a doctor since 1967.

One follow up question please. I'm a nomad. I wander and can't meet the residency requirements of any state. I have no legal address. I have mail sent to general delivery someplace where I expect to be in the future. I suppose I'll have to repeat the living will in every state I visit and to fingerprint the wills and attach a photo in lieu of an address.

Would it satisfy the legal requirements if I post all my living wills online then tattoo the shortened URL on my body? I looked at the living will web pages of a couple of states, and they offer no guidance.

I can't resist a political whine. Life was so much easier before government said, "I'm here to help you."

 

[russ_watters]

I suppose I'll have to repeat the living will in every state I visit and to fingerprint the wills and attach a photo in lieu of an address.

Would it satisfy the legal requirements if I post all my living wills online then tattoo the shortened URL on my body?

Try this:
https://www.uslivingwillregistry.com/walletcard.shtm