Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 15 Bereavement and Grief 307
to natural death. If they are slow and infirm they may impede rescuers.
They are liable to have multiple physical illnesses reducing their quality
of life. They are also more liable to have mental illnesses, especially dementia,
that alter their status as persons worthy of saving. People with
these illnesses are often segregated into institutions such as nursing homes
(Birkett, 2001). Such considerations suggest that all life is not equally
valuable, which may not be openly expressed when officially preparing
for disasters. In the actual situation when a choice has to be made between
saving those trapped in a nursing home and those trapped in a school,
ageism may become a factor.
LITIGATION
Does DNR Mean Do Not Rescue?
DNR, meaning do not resuscitate, was originally an informal coded message
left on the charts of some terminal hospital patients at the discretion
of doctors. Such informal reliance on medical authority has now given
way, in most jurisdictions, to a proliferation of living wills, health care
proxies, and so forth. Many controversies surround this area. Questions
have been raised about whether euthanasia and assisted suicide should
be legalized and whether those who suffer from severe depression or
dementia are capable of deciding their own fates. It was hoped that the
wisdom of governments would resolve these issues, but doubts remain,
especially in emergency situations (Hoffman, 2006).
The resuscitation referred to in DNR is narrowly defined in most
American states. It refers only to procedures such as cardiopulmonary resuscitation
or advanced cardiac life support and does not prohibit a life
being saved in other circumstances. The existence of a DNR order could
possibly affect the zeal of aid workers under stress. It could also give rise
to suspicions and misunderstandings.
In 2005, when New Orleans was flooded by Hurricane Katrina, the
following message were sent:
This is quick; don’t know how much longer we have use of the computer.
Things are really bad. Please take a minute to call for someone to ask for
more assistance for us. We are at Memorial Medical Center. One of the
nurse’s husband is here — he is a lawyer, made some calls so help may be
coming. I will be in touch — the plan is to evacuate the sickest fi rst then