[txspadequeen921]

Here you go .

REVOCATION:
The Out-of-Hospital Do-Not-Resuscitate Order may be revoked at ANY time by the patient OR the patient’s Legal Guardian/Agent/Managing Conser-
vator/Qualified Relative, Parent (if a minor), or physician who executed the order. The revocation may involve the communication of wishes to
responding health care professionals, destruction of the form, or removal of all or any Do-Not-Resuscitate identification devices the patient may possess.
AUTOMATIC REVOCATION: This Out-of-Hospital DNR order is automatically revoked if the patient is known to be pregnant or in the case of
unnatural or suspicious circumstances.
This came straight from http://www.tdh.state.tx.us/hcqslems/dnr.pdf
of course this is in Texas ,So im not sure about other states. If you cannot get it by typing in the website, I typed in Texas DNR and chose the title that said 1, of course this is from MSN. I work with this everyday in hospice, just had a situation yesterday when the patient had a DNR and the pt died while the family was there , they demanded CPR and verbally withdrew the DNR. We were then required to call a full code and call EMS. Not fair but the law.

Originally Posted by earle58

i don't think so at all.
if a patient has a dnr in writing, why would anyone have the right to override that?

i'm checking with my nurse's association on this.

leslie

[earle58]

Originally Posted by txspadequeen921

Here you go .

REVOCATION:
The Out-of-Hospital Do-Not-Resuscitate Order may be revoked at ANY time by the patient OR the patient’s Legal Guardian/Agent/Managing Conser-
vator/Qualified Relative, Parent (if a minor), or physician who executed the order. The revocation may involve the communication of wishes to
responding health care professionals, destruction of the form, or removal of all or any Do-Not-Resuscitate identification devices the patient may possess.
AUTOMATIC REVOCATION: This Out-of-Hospital DNR order is automatically revoked if the patient is known to be pregnant or in the case of
unnatural or suspicious circumstances.
This came straight from http://www.tdh.state.tx.us/hcqslems/dnr.pdf
of course this is in Texas ,So im not sure about other states. If you cannot get it by typing in the website, I typed in Texas DNR and chose the title that said 1, of course this is from MSN. I work with this everyday in hospice, just had a situation yesterday when the patient had a DNR and the pt died while the family was there , they demanded CPR and verbally withdrew the DNR. We were then required to call a full code and call EMS. Not fair but the law.

i find this incredulous as well as non-sensical. i too work in hospice and have worked with a few pts who were obviously dnr and the family (poa present) wanted it rescinded. I told them that i had to honor the wishes of the patient; and then later i talked with the family how their reactions were normal and i empathized with them. no lawsuits.

but IF this is true in all states, what about pt autonomy and self-will, and a living will? why would anyone allow this to be dismissed as if the pt had no rights whatsoever?

leslie

[txspadequeen921]

We dont know about what these families have talked about behind closed doors or the agreements made between them. I agree with folowing the pateints wishes. However, the patient did give the POA the right to change ,add or subtract care as he/she sees fit. And the patient knows this upon signing a DNR, it is not my job to deny ,restrict or judge a family or POA for excusing a DNR. I do realize the familys get scared and shaken at the point of the death of a loved one. But instead of refusing them the right to remove the DNR, it is time to have a talk. The majority of the time that is all it takes , a reality check. When they find out what we are about to do to their loved one , bag ,compress and intubate. Things turn around fast. By denying them the right to revoke that DNR you are setting yourself up for a day in court.

Originally Posted by earle58

i find this incredulous as well as non-sensical. i too work in hospice and have worked with a few pts who were obviously dnr and the family (poa present) wanted it rescinded. I told them that i had to honor the wishes of the patient; and then later i talked with the family how their reactions were normal and i empathized with them. no lawsuits.

but IF this is true in all states, what about pt autonomy and self-will, and a living will? why would anyone allow this to be dismissed as if the pt had no rights whatsoever?

leslie

[earle58]

Originally Posted by txspadequeen921

We dont know about what these families have talked about behind closed doors or the agreements made between them. I agree with folowing the pateints wishes. However, the patient did give the POA the right to change ,add or subtract care as he/she sees fit. And the patient knows this upon signing a DNR, it is not my job to deny ,restrict or judge a family or POA for excusing a DNR. I do realize the familys get scared and shaken at the point of the death of a loved one. But instead of refusing them the right to remove the DNR, it is time to have a talk. The majority of the time that is all it takes , a reality check. When they find out what we are about to do to their loved one , bag ,compress and intubate. Things turn around fast. By denying them the right to revoke that DNR you are setting yourself up for a day in court.

the patient knows that the poa can reverse the dnr?

[txspadequeen921]

Of course they do, it is on the actual DNR form, the revocating provisions I posted before came off the Texas DNR form.

Originally Posted by earle58

the patient knows that the poa can reverse the dnr?

[aimeee]

Originally Posted by earle58

but IF this is true in all states, what about pt autonomy and self-will, and a living will? why would anyone allow this to be dismissed as if the pt had no rights whatsoever?

leslie

I don't know if it is true in all states, but it is true in Michigan too:

The order may be revoked at any time by the person who made it, or by her or his patient advocate.

Once you become incapacitated, your POA/medical proxy (if you have appointed one) has been empowered to make decisions AS IF THEY WERE YOU. When you sign that POA, you are giving them them your rights. This is why you must choose your POA wisely and make sure they understand your wishes and will honor them. They are under no legal obligation to do so.

When the POA wants to make a decision contrary to the advance directives, it is often sufficient to remind them that the patient made his/her wishes quite clear and that in accepting the role of POA they made a committment to uphold their wishes. Reminding them that the patient chose THEM to be POA because they believed they would honor their wishes helps them look at it from the patient's perspective.

[jerseyRN]

What a nightmare.

I think in most cases CPR would be started as a CYA measure. But it seems to go against intent of the patient.

[elkpark]

I worked closely with the legal department of a big teaching hospital when I was doing psych consultation liaison work a few years ago, and this kind of situation came up all the time. Yes, if you have executed a DPOA for healthcare, then, once you are incapacitated or unable to communicate your wishes, the person you have designated is charged with making all decisions regarding your healthcare on your behalf, which could/would certainly include rescinding a DNR order.

However, even if that were not the case legally, most hospitals err on the side of caution and go along with whatever the family members want over what the patient wants -- I have heard hospital legal counsel and administrators comment more than once that the hospital faces a much greater risk of being sued by the surviving family member (for letting Poppa die ...) then they do of being sued by the patient if he actually survives being coded when he didn't want to be ...

[bellcollector]

Personally I think it is a shame. What is the point in having a DNR? I understand the need for someone to make decisions for me concerning my medical care for things such as emergency surgery or something like that should I be incapacitated. However if I am in a hospice type of situation or terminally ill I would not want my POA to suddenly panic and put me through all that when the end came.

[Chad_KY_SRNA]

At my facility the DNR is usually respected but if the POA is present and requests us to do a full code we must. It usually doesn't make any difference in the end medically. I used to date a paramedic, who had worked EMS for years and never saw a sucessful full code from a nursing home. The family gets a brief moment of hope before the inevitable, the staff is forced to physically violate the resident who they have grown to love. Its bad for all involved.

I was wondering if the OP had this happen, how was it handled?