Legal question?/ What would you do?

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    I'd love to get some feedback on a situation that happened recently during the night. We coded a patient twice within a few hours; by the time the second code started the family was all present including the husband. The next of kin approached the nurse and wanted the pt to be made DNR and the MD gave a telephone order for that. The pt had been on pressors prior to the code but was hypertensive afterwards d/t all the epi given. When the bp started dropping again the family requested to have the medication kept off, in other words they decided that they wanted only comfort measures. At this point, however, (about 5am) no one could get the intensivist on the phone after multiple pages/calls to the answering service.

    So my question at this point is, does next of kin have the right to refuse medications in the same way that a pt can refuse medications, and does it make a difference that the pt would soon die without said medications?

    Ethically speaking, in this situation I would want to honor the family's wishes (they were an intelligent, caring, lovely family) but do I have legal ground to stand on?
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  4. 0
    Well then what ,if a patients daughter is saying the wrong person is appointed POA, she is challenging this and wants to see Admission Papers,and the Risk management is refusing to allow a meeting, I wanted to help and I know the daughter is right! State Law is when a person is single the Children are the Next of KIN,this Patient signed "NO POA/No Advanced Directives, and discounts the old one ,to facility as well as members of family pre admission Old POA from 2003. It is now 2006. She is insisting that Patients SISTER is not who he wants,as his POA. This patient is post CABG, ">24 hrs emergency " bleeding evaluation",RE-Entry something was very wrong,I knew it, Then there was a rule out for needle count. We were instructed to say Nothing to this daughter. She was terrified for her father. To see her praying and asking,yet staying calm,in fear of her removal
    Patients NOK simply wants a second opinion,and if his state is futile then Hospice. This patient later remained on vent, received blood 6 months, moved to forth floor to a HH.NOK's visits were limited by Risk management,and then was removed, she filed and made too many complaints. She was allmost desperate for her father and his comfort,stated he is being tortured and aunt is allowing this ,I am his POA not her!,and the Allowed POA ,a aunt was not active in care,only responded with yes,or a derogatory remark towards patients NOK,like daughter will give pain medication to patient,and POA stated she/NOK made threats. I perceived this as a Power Struggle and nothing less.
    What could I have done,This haunts me to this day. What would happen if I located this NOK and told her what I know,really happened,it has been 3 years and statue has passed. It repeats in my mind this poor woman. I should have gone to some one?
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    Depending on the state where you live will drive the response. In CA a durable power of attorney for healthcare decisions or conservatorship that includes healthcare decision making power is who we would look to. If none of the above exist then patients spouse, living children etc would be the decision makers.
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    In response to post. Husband is first, if no husband and children it is oldest child over 18, then diverts to parent of pt if none of the rest, never made it farther than that it is the law in our state. Yes the dnr includes any medications that are considered code meds including epinephrine. So stopping them is part of the DNR. Don't know about the verbal DNR. I would be extremely uncomfortable to initiate the DNR if the husband you spoke of had not signed the DNR form at your facility.
  7. 0
    That's a good one! You still have orders to treat the patient even though he's a Do Not Resuscitate. Turning the drips back on isn't coding him. Until I could get the attending or who's ever on call now, back on the phone, I'd still treat the patient and try to keep him stable until all that legal stuff can be sorted out. Even if you allow him to code a second time, and die, it doesn't sound like anyone would be upset, but you never know.

    So, what actually happened?
  8. 0
    If the family is present and they are in agreement, generally we honor their wishes. Why did you need the intensivist? I thought you got an order for a DNR couldn't that Md give you further orders if needed?
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    Wow this is a really late reply What happened was the nurse caring for the patient didn't turn on the pressors because the all the family present, including the legal next of kin, were all in agreement that they didn't want to accelerate care. However, when the intensivist finally came in, he was angry. He hadn't responded to all the calls and pages but he was mad that he hadn't given the order for comfort measures only but the nurse did it anyway.


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