European Stars And Stripes (Newspaper) - February 28, 1989, Darmstadt, Hesse                                Saying no to cardiac resuscitation by Allan Parachini los Angeles times he Middle aged stroke victim Lay on her Back in her room in the intensive care unit at Huntington memorial Hospital in Pasadena calif., a Respirator keeping her alive. At the nearby nursing station supervisor Zorka Barabas glanced at the woman then at a television Monitor that tracked her heartbeat. In the woman s room nurses and technicians hovered at the bedside adjusting equipment and caring for her just As they do for the other 19 patients in intensive care. But prominent in the woman s medical record were the words no code Blue followed by a doctor s jottings spoke with family regarding patient s extremely poor condition and prognosis. Family requests no code. Will comply with  the patient it turned out had less than 24 hours to live. She went into cardiac arrest the following Day and Hospital personnel honoured those specific orders written in her medical Chart. They Are orders that Are becoming increasingly common in the United states even dominant among terminal patients. To a growing number of medical ethics experts those orders Are proof of a tidal change in How americans Over the last decade have come to grips with the question of death. In increasing numbers they or their families when they Are incapable of making such choices for themselves Are simply saying no to the use of exotic technology and heroic Hospital Rescue procedures. The mechanism by which this is being done is most commonly called a do not resuscitate order or Der. In Hospital shorthand parlance it is referred to As a no code meaning that cardiac resuscitation and other massive interventions to prolong life Are not to be undertaken. Although there is no comprehensive National statistical profile of dvrs doctors at a Hospital in new Britain conn., reported last month that almost two thirds of intensive care patients who die do so with Der orders in effect. The researchers in a report published in the prominent journal archives of internal Medicine found that in 1986, dvrs were in effect for 64 percent of the intensive care patients who died while four years earlier dvrs were in effect for Only 27 percent of similar patients who died. This study the researchers concluded finds that Der orders have become the Rule rather than the  Many biomedical ethics experts agree that dvrs now prevail among most groups of terminally ill patients. There is no question now that there is greatly increased acceptance of Der orders said or. Michael Van Scoy Mosher a tumor treatment specialist who Heads the bioethics committee at Cedars Sinai Hospital in los Angeles. It has become a very accepted and commonplace  it certainly seems to Bear up All across the country said or. William Bartholome an ethics expert at Kansas University medical Center in Kansas City Kan. I think people Are finally coming to the realization that it is very  the increasing acceptance of dvrs has come almost directly from the development Over the last 15 years of new technology that can sustain life or even return to life patients who would once have been termed clinically dead. Studies of the eventual outcomes of patients resuscitated in hospitals have consistently found Only a 5 percent to 20 percent Success rate when the outcome is measured in terms of whether the patient was eventually discharged in reasonably Good health. In 1983, for instance researchers at Beth Israel Hospital in Boston found that of 294 patients resuscitated in a major teaching Hospital Only 14 percent survived to be discharged and a Quarter of those died within six months. There has also been concern about pain and a nurse adjusts a heart Monitor in an intensive care Ward today s terminally ill patients increasingly Are rejecting use of the latest technology and Hospital Rescue procedures. Not suffering caused by resuscitation itself. Successful car even when performed on resilient younger people usually results in injuries such As broken ribs. It can be extremely traumatic in older ill victims. The whole process of resuscitation is a very brutal one Stanford University s or. John Ruark said and certainly in the Case of the debilitated older person it s difficult to make a Case that it should be undertaken at  the question is where do you Stop i think we All know that you re not always doing people a service by resuscitating them said or. Palmi Jonsson the doctor who headed the Connecticut study. The increasing popularity of do not resuscitate orders poses a major Challenge to physicians and the health care Community. Most experts questioned by the los Angeles times agreed that the increased use of dvrs has developed at the grass roots level among health care Consumers. The newly published study found that almost two thirds of the dvrs were written Only within the last three Days of the patient s life. What that indicates is that the Issue arose too late Capron said. I suspect it reflects the fact that although Der orders Are no longer secret there still in t Comfort in the medical Community with making this a Standard topic of  specifically the experts suggest that All adults should decide what they would specifically want done in the event they suffer a medical catastrophe and they should discuss such wishes in detail with their families and with their physicians. In most states a document called a durable Power of attorney can be used to specify someone who is empowered to make choices for you on questions that include the Issue of resuscitation if you Are unable to do so. In new York state a first in the nation Law that took effect last april guarantees adults the right to have their wishes not to be resuscitated honoured. But even with such a document you should make sure both family members and physicians who May be involved in your treatment understand precisely what heroic measures Are wanted. Someone with a heart condition for instance May wish to have car performed if it can be initiated quickly enough to avoid brain damage but May not want anything to be done should there be a delay. Tuesday february 28, 1989 the stars and stripes Page 13