Hello, Allnurse peers. I'm probably about to "preach to the choir", although as always I would welcome your advice, support and wisdom. I sit on the ethics board of the hospital where I work, and the topic came up of an elderly end-of-life gentleman with an out-of-hospital DNR who appeared to have had a a respiratory distress at home. The wife, who at the end couldn't cope with the idea of him dying there in pain, in the home with her by herself, called EMS, who naturally took him to the ER, where these trained professionals naturally did what they were trained to do: they intubated and coded him. The wife was distraught, and so was the patient when he woke up and realized that what was done to him was exactly what he didn't want done.
ERs are for emergencies, just like it says. They are places where trained multidisciplinary specialists do everything they can to keep viable people among the living. They aren't places for people to be brought to die, and the professionals attracted to this speciality usually aren't hard-wired to stand to the side, push morphine, hold a hand and LET someone die. Even if they were, in today's litigious climate, who can afford to take the time to say, "What is this patient's code status?" before you jump on his chest, bust his ribs, cram a tube down his throat, etc.
On the other hand, who can feel anything but pity for an elderly woman alone in the middle of the night with a husband who is suffering as he departs this world? Who can blame her for picking up the phone and dialing 911?
If in addition to our ERs, wouldn't it serve a purpose to have a "D.R", a Departure Room where persons who were in distress or dying, but didn't want all of our technological wonders performed on them, could be brought for pain and anxiety relief and spiritual support as they and their loved ones make this final journey? Probably not cost efficient (and how would you code and bill for it?). Ideally there is Hospice, but for a variety of reasons, not all of these people are Hospice candidates.
What are you doing at your progressive insititutions? Thoughts, feelings, feedback, ideas? Thank you, JeannieM