DNR Orders Overturned By Doctors

Nurses General Nursing

Published

Hi,

I am a nursing student and my husband is a RN in an ICU. He tells me that a patient will come in as a DNR and then the patients family will talk to the doctor and then the doctor will change the patients code status to full code.

Why do you think this happens? It's my understanding that if the patient wanted to be DNR, this should be respected regardless of how the family feels about it. Doesn't the doctor have a legal responsibility to respect the patients signed DNR order?

Do you think this happens because doctors don't want to have a confrontation with the family and it's "easier" to comply with the families wishes rather than have the family feel as though the doctor is "letting" the patient die?

My husband tells me that a lot of the patients in the ICU are from nursing homes, have severe dementia and are bed bound, with minimal to no LOC. It seems sad to me that they are being kept alive on ventilators against their documented wishes.

Is this legal? Is it ethical? Is it prevalent in your experiences as RN's? Or is the hospital my husband works at the exception?

Thanks for any feedback you are able to offer. I'm just sort of baffled by this issue. :o

Specializes in ER OR LTC Code Blue Trauma Dog.
Not any more so than, oh say virtually any other politician, conservative or liberal, most of whom can be cited as doing the same thing, as often or more so, even when they complain about it in others. And I still don't get where it has anything to do DNRs. Nor what was humorous about it.

Would it not be more accurate to just say "flip-flop" or "changeable" , something that does have a clear meaning, and has no inherent bias to a certain mindset. Given that we are talking about a medical issue such as DNRs..an important topic that deserves attention on it's own.

Gee... I sure am glad you are here to give my postings such an in depth analysis. Your most valuable opinion has been noted.

My Best.

0 Votes
The doc is damned if he does and damned if he does not. Just one family member saying do all is enough for most to back off the DNR. But if the pt recovers and finds out they were resusitated when asked not to be, the doc can also be sued. Ethic committees are great for helping out here. I have seen doc take the chance and follow the pt's wish,especially if they had talked to the pt themselves at some point. If the DNR is signed,witness,specific to detail and legal, then Doc's really should adhere by them no matter what.Documention is key in all these cases.

If the pt does recover, he ought to sue not only the doctor, but also the family members who insisted the doctor act against the DNR.

In some cases, some family member might be siphoning off grandpa's SSI or other retirement payments, and if grandpa is no more, then there goes the income. It happens.

0 Votes
Specializes in Trauma ICU,ER,ACLS/BLS instructor.
If the pt does recover, he ought to sue not only the doctor, but also the family members who insisted the doctor act against the DNR.

In some cases, some family member might be siphoning off grandpa's SSI or other retirement payments, and if grandpa is no more, then there goes the income. It happens.

One never knows!

0 Votes
When it comes to listening to the family members vs pt wishes on issues of DNRs/organ donation ect. I heard a good saying once...

"Dead people don't sue....it's the ones still alive that do"

Or their family.

0 Votes
Actually I think it was the op just venting and got carried away, as most of us have and do when we r passionate about something. I think we should all play nice .

I am the OP and I never mentioned anything about John Kerry/George Bush, Lady Bird Johnson, or Good ol' honest Abe. Just wondering about DNR's and such. Simple case of mistaken identity I'm sure ;)

0 Votes

In some cases, some family member might be siphoning off grandpa's SSI or other retirement payments, and if grandpa is no more, then there goes the income. It happens.

I had a coworker who worked ICU for over 10 years tell me that family members would ask if grandma/grandpa could be kept alive until at least the end of the month so they could "get the check". That's despicable.

0 Votes
Specializes in icu, er, transplant, case management, ps.

In order for someone to receive another's social security benefit, the person receiving the benefit must sign a form,witnessed. The direct deposit check is then deposited into that account. It is not as easy as many seem to think it is, to obtain someone else's benefit check. And the comment about people wanting 'granny' kept alive until the end of the month is just hogwash. Death and benefits are tied into a monthly cycle. Die anytime during the cycle, regardless if it is the first day or the last day, the benefit must be repaid. A death certificate must be provided to the S.S.A. Failure to do so and to continue to collect even one month's benefit is against the law. Woe be it to anyone who thinks the federal government will not come after them for just one payment.

Woody:balloons:

0 Votes
Specializes in Med Surg, Hospice.

I have my living will and DNR orders locked away in my safe deposit box. My family and I have discussed possible medical care if it comes down to this. I have told them in no uncertain terms that if they even TRY to undo the DNR, I will come back and haunt them for the rest of their lives. I think they understand things better now since we all made the joint decision (Mother, me, siblings) to take my father off of the vent once we found out that there was no hope or quality of life left.

0 Votes

i shudder to think what would happen if the foley wasn't irrigated, pending md order?

seriously.

what if it went to court r/t some sort of trauma sustained...and a nurse didn't dare to irrigate w/o an order (very understandable, btw!!).

are we dictated by the confines of our licenses or by the parameters of what a "prudent nurse would do?"

certainly, the soc and a perceivably supportive measure, would lead a prudent nurse to irrigate, freeing the obstxn.

but the flip side IS what to do in absence of md order?

tough call...

i know i would irrigate.

but would my bon understand???

leslie

0 Votes
Specializes in Emergency & Trauma/Adult ICU.
In order for someone to receive another's social security benefit, the person receiving the benefit must sign a form,witnessed. The direct deposit check is then deposited into that account. It is not as easy as many seem to think it is, to obtain someone else's benefit check. And the comment about people wanting 'granny' kept alive until the end of the month is just hogwash. Death and benefits are tied into a monthly cycle. Die anytime during the cycle, regardless if it is the first day or the last day, the benefit must be repaid. A death certificate must be provided to the S.S.A. Failure to do so and to continue to collect even one month's benefit is against the law. Woe be it to anyone who thinks the federal government will not come after them for just one payment.

Woody:balloons:

Woody, I'm sorry, but this post, like several of your other posts regarding other government benefits, reflects the "letter of the law" but does not take into account the countless ways that people live within the system or subvert the system every single day.

People live together and support each other financially in every imaginable way. Family or significant others may well agree to live together or otherwise financially support each other with the full knowledge and agreement of the SSI recipient. And at the other end of the spectrum, people certainly do unfortunately rip off the vulnerable elderly. I have an elderly relative, an SSI recipient, for whom I provide care. We have a joint checking account in both our names into which her social security check is direct deposited. All I would have to do to use her SSI money would be to write myself a check out of our joint account. You are assuming that the only way that a family member, friend, significant other, etc. could access an SSI's funds would be to have a form witnessed, etc. ... and it just ain't so.

Oh, and if grandma is alive on September 30, that check will be deposited on October 3. Maybe Grandma's relatives are despicable money-grubbers ... or maybe they're just trying to make sure the rent can be paid on the apartment they all live in. It's the following deposit, on November 3, that would have to be paid back to SSI.

0 Votes
i shudder to think what would happen if the foley wasn't irrigated, pending md order?

seriously.

what if it went to court r/t some sort of trauma sustained...and a nurse didn't dare to irrigate w/o an order (very understandable, btw!!).

are we dictated by the confines of our licenses or by the parameters of what a "prudent nurse would do?"

certainly, the soc and a perceivably supportive measure, would lead a prudent nurse to irrigate, freeing the obstxn.

but the flip side IS what to do in absence of md order?

tough call...

i know i would irrigate.

but would my bon understand???

leslie

dang, i posted this in the wrong thread.

sheesh.

tgif.

leslie

0 Votes
Specializes in icu, er, transplant, case management, ps.
Woody, I'm sorry, but this post, like several of your other posts regarding other government benefits, reflects the "letter of the law" but does not take into account the countless ways that people live within the system or subvert the system every single day.

People live together and support each other financially in every imaginable way. Family or significant others may well agree to live together or otherwise financially support each other with the full knowledge and agreement of the SSI recipient. And at the other end of the spectrum, people certainly do unfortunately rip off the vulnerable elderly. I have an elderly relative, an SSI recipient, for whom I provide care. We have a joint checking account in both our names into which her social security check is direct deposited. All I would have to do to use her SSI money would be to write myself a check out of our joint account. You are assuming that the only way that a family member, friend, significant other, etc. could access an SSI's funds would be to have a form witnessed, etc. ... and it just ain't so.

Oh, and if grandma is alive on September 30, that check will be deposited on October 3. Maybe Grandma's relatives are despicable money-grubbers ... or maybe they're just trying to make sure the rent can be paid on the apartment they all live in. It's the following deposit, on November 3, that would have to be paid back to SSI.

One of the major problems of this country is that numerous people are aware of the frauds committed against our state and federal systems. But very few of them ever report these violations to the appropriate authorities. It seems like people would rather complain about all these frauds rather then report them. I found this to be true, even on this board.

Yes, my post follows the letter of the law. And if and when I have knowledge, I do report it. I have always taken my responsibilities, as a citizen of this country seriously. I flew to NYC several times, to testify at criminal trials of violators of Medicaid laws. All I got was my plane fare and hotel paid for. And I lost on an average of more then $250 a day in earnings while out of the state. But my Dad had raised me to be a responsible person.

Woody:balloons:

0 Votes
+ Add a Comment