Do Not Resuscitate

"If I don't appeal this, I could never claim that what they said wasn't true.  I really have no choice.
"I want my name cleared: on this piece of paper, it says I did not comply with my father's wishes.  But I did."   Diana Ford

Did she?  Perhaps not, quite seriously perhaps not, although she seems to believe that she observed the letter of her father's instructions.  Had she done so, the outcome would not have been what did occur, however.  Her father, 89, and suffering the dreadful after-effects of a serious car accident, was at The Ottawa Hospital for a full eighteen months.  Gustav Spindler was no ordinary patient, and eighteen months is a long hospital stay.

He was unconscious when he was airlifted, post-accident, to The Ottawa Hospital.  He had broken ribs, a fractured clavicle, broken vertebrae, spinal cord injuries and a serious head injury.  Doctors informed his only daughter, Diana Ford, that they doubted he would survive.  While in hospital for that year-and-a-half, he was rushed to the intensive care unit on five occasions.  He lost the use of his limbs, was fed by a percutaneous tube, was unable to speak.

Mr. Spindler, a Holocaust survivor, suffered blood clots in his legs.  He had suffered many bouts of pneumonia requiring suctioning of his airway.  Pneumonia was what finally killed him.  His admitting physician had asked Ms. Ford to sign a DNR order that would exclude chest compressions, defibrillation or mechanical ventilation if he were to suffer a heart attack.  Mr. Spindler had suffered from coronary artery disease.

For a man approaching 90, a man in perilous physical condition, extraordinary medical manoeuvres like chest compressions represented brutal intervention that would most certainly cause pain and suffering aside from the possibility of additional physical break-down occurring.  The hospital planned to remove Mr. Spindler from a vital-signs-monitoring device, and to prepare him for a move to a long-term care facility.  All of which his daughter opposed.

Ms. Ford consistently refused to allow her father to be transferred to long-term care.  She refused to accept doctors' conclusions that he was permanently incapacitated by his manifold physical injuries.  She insisted on care and treatment that would result in a "cure" for her father's fragile, dessicated condition.  And she took severe umbrage at the doctors' questioning of her insistence on a cure for her father: "How dare I want them to cure him?"

Mr. Spindler's resuscitation code status was a source of repeated clashes between doctors and his daughter who accused the hospital and the doctors and the nursing staff of neglecting her father, paying attention to other patients whose need was not as great as her father's - because they were young and he was not.  Ontario's Consent and Capacity Board was asked on two occasions to settle issues disputed by Mr. Spindler's daughter relating to his care.

Mr. Spindler had legally handed over power of attorney to his daughter.  She absolutely rejected the "do not resuscitate" orders, the projected transfer to long-term care, and the decision to remove his vital-signs monitor that all the attending doctors repeatedly said was no longer required.  Mr. Spindler had signed the power of attorney placing his daughter in charge of his welfare in the event of a catastrophic deterioration of his health and physical condition.

He carefully set out the terms of the power of attorney, naming his daughter as his "lawful attorney ... to carefully consider that it is my specific wish and desire that I do not want my life to be prolonged and I do not want life-sustaining treatment to be provided or continued if I am in an irreversible coma or persistent vegetative state."  The document that he worded so carefully gave instructions to his daughter to make similar decisions "under any circumstances where the burden of the treatment outweigh the unexpected benefits."

Clear and concise.  Language not susceptible to contradictory interpretation.  Despite which Ms. Ford made her own interpretation of her father's wishes.  "To put up with all this and be able to survive all this and still want to live; let me tell you, at that age, the elderly, if they don't want to live, they just let go and die" she claimed, insisting that her father's will to live was strong.  So strong that the suffering he went through while in hospital, undergoing various health attacks on his already-frail and failing body proved just that.

The Ottawa Hospital believes the treatment it offered Mr. Spindler was appropriate to the level of care he required throughout his length stay in the intensive care, trauma and alternative care units.  "We always try to respect the wishes of the patient", explained a hospital spokesperson.  Obviously, the hospital usually has to deal with upset and traumatized family members grieving for their loved ones, but rarely, one might assume, one as intransigently aggressive and ill-informed as Ms. Ford.

Her seriously sick and life-failing father suffered enormously and she was more than willing to have him continue suffering to satisfy her commitment to what she believed he wanted, despite his obviously determined attempt to advise otherwise through his carefully worded instructions.

It appears that his daughter is far more concerned with having her opinion of herself as the final authority and arbiter of her father's care restored through having her "name cleared", than facing the injustice she was responsible for in deliberately misinterpreting her father's end-of-life directions for care.

To which end she is appealing a legal ruling that gave The Ottawa Hospital clearance to withhold lifesaving treatment from her father, launching the appeal in Ontario Superior Court, though her father died on July 11.