In this morning's NY TIMES, I read an astounding article about a person who took his advance directives so seriously that he had them tattooed on his chest: His Tattoo Said ‘Do Not Resuscitate.' Doctors Wanted Another Opinion. - The New York Times
Why should a step like this be necessary? Why is it that with our EMRs, our focus on paperwork, and our multitudinous permission slips on admission--why is it that something radical like this has happened? Did this man fear that his wishes would not be honored? Was he afraid that someone wouldn't be able to find the paperwork?
As the article points out, he came in unaccompanied and unconscious--a challenging situation for the care team no matter what. After consulting an ethicist, they honored his stated wishes and he died.
What are your thoughts on this?
How can we improve our end of life conversations?
Do you have some ideas about what we could do better?
How can our current EMRs help or hinder?
EDITED TO ADD
After reading this story, I was prompted to write an article about the necessity of talking to our patients about their end of life decisions. To read the article, go to Can We Talk? End of Life Discussions
Dec 5, '17
This happens because people do not trust doctors. And, honestly, they have their reasons. In today's legal climate, I am surprised that docs finally honored the will of the patient.
Hospital lawyers can say whatever but, should something happen, they won't sweat much over it. The MD/DO who signed the chart will get it all. I'd seen patients with clearly stated wishes of "DNR" coded and resustitated because the living will was signed whole half a year ago and "who knows, the guy might change his opinion, so we better be on a safe side" or because "you know what sort of family it is - I do not want problems with them, let them know that everything was done". Or just because it was Trauma Code Lever 1 and senior resident really wanted to run the show (and later he was not reprimanded for doing that).
Re. end of life conversations, they just gotta have happen, and to be in clear, unequivocal English or whatever first language patient/family prefers. Again, it is my personal experience, but I have a strong impression that an average hospital visitor or nursing home resident's DPA has no idea whatsoever what is implied under those "code papers", and still much less about what pretty frequently happens after a successful code (meaning horrendous and very difficult to control pain from broken ribs, hypoxemic encephalopathy and multiorgan failure). That needs to be changed, and if there are going to be specially trained and purposefully delegated for this and similar tasks RNs to conduct these talks (instead of the staff nurse who is running through X+1 admission of her shift with no chance to pee for the last 10 hours), then so be it.
Last edit by KatieMI on Dec 5, '17