Lee, aged 75, had all the trappings of chronic illness: hypertension, diabetes, high cholesterol, heart disease, and she had a previous stroke. She wore a prominent "DNR" wristband. Staff at her care facility called EMS when she experienced flash pulmonary edema and was struggling to breathe. Lee arrived in the emergency department with a
verbal directive that she was not to be intubated or given sedation. She only wished to be "stabilized." What did this mean? Was she really willing to die, or did she want to live?
She finally agreed to BiPAP, a pressured oxygen mask strapped to her face. Medication was given to lower her blood pressure and to slow her heart rate. Over the next 30 minutes, her condition stabilized. Even her heart rate converted from atrial fibrillation to a normal sinus rhythm. She politely extended her hand to shake the ED physician’s
hand and said, "Thank you."
For all intents and purposes, it appeared that the physician had resuscitated Lee against her wishes . . . or did he? The questions that surround ambiguity cannot be taken lightly in the extremes between life and death. Healthcare providers especially need definitive answers if they're to be held liable for either wrongful death and/or
the full resuscitation of a patient.
Ambiguity is present with "both-and" thinking that permits patients to have it both ways. Definitive action requires an "either-or" approach that allows patients to have it one way or the other. Most patients prefer to live AND let die, depending upon the circumstances. At what point do patients declare, "Give me quality
of life OR give me quality of death?" In Lee’s situation, her DNR bracelet was more ambiguous than definitive, requiring that the physician read between the lines of what this patient wanted.
Better communication begins with distinguishing "both-and" considerations from "either-or" decisions:
