not coding a non dnr patient

[acerila]

Have any of you ever had a patient who wasn't DNR and was not coded?

Let me tell you the story behind this question. I just recently graduated and I work in the NICU. The baby was about 5 months old, just got a trach done and basically had many issues & was never going to have a normal life. We all thought the patient should be DNR but the parents wanted everything done. It seemed like the pt was getting a litte bit better after the trach but then a few days ago (I wasn't there that day and neither was his primary doctor) she started going down hill all day long to the point where her heart rate and sats dropped and they were bagging her with no response. The doctor on call that day instead of starting a code came in and said that it looks like this is it for her and nothing else was done & I guess no one spoke up.

Now what do you guys think? One part of me knows it was for the better and if it was up to me I wouldn't want to code her but it wasn't our decision. The parents wanted everything done and I know her primary doctor did as well (he referred to her as his daughter and before he left the day before he told her that "dr..... loves you"). So now the two doctors are going to probably have a big falling out once her primary finds out nothing was done. And what about the parents, I'm sure the hospital can get in a lot of legal trouble, right?

[IndySkies]

I know this opinion will probably not be popular, and in this litigitous society you would probably be setting your self up for a law suit, but I have been to more than one ethic and standards confernece in my 30 years as a nurse and the conference chairperson or one of the speakers inevitably states something to the fact that..."no physician is obligated to code a hopeless case..." Now before you think this is wrong how many 'slow codes' and 'fake codes' and 'short codes' have you seen...usually the hours-long codes I have been in have either been a young person with unexpected arrests, or in a teaching facility with residents to gain experience. In private practices most codes do not seem to go on very long if there is not an immediate response with stable vital signs

[Nurse_Wretched]

If anything ever happens to me that renders me barely functional and unable to lead a 'normal' existence, I hope that someone has the sense to let me go! This MD did the right thing. Now the family can move on... What really scares me is when physician's treat patients until they are dead. I had a few really critical dialysis patients that were so sick that they died within days of stopping treatment. One lady would fill up with fluid just hours after returning from treatment. Ridiculous!

[Faeriewand, ASN, RN]

This is where it is really different in the UK, over here we make the judgment then discuss it with the family but legally it is the decision of the medical team and not the family. We have no legal need to ask consent

Now that's really interesting. I learned something today. Thanks for the information.

[Nurse_Wretched]

"no physician is obligated to code a hopeless case..."

This is not practiced anywhere near as much as it should be!

[pywon8]

Yeah, I did agree with some of you all ,saying that Doc have to right to decide whether to code a patient depend on patient condition. Even in my country, some of the patient was not code even DNR was not issued. However, doc will keep reinforced to the patient family members about the condition of the patient is very ill.

[jojotoo, RN]

In some States it is legal for the Doctor to make a pt DNR without the next of kin's approval. Where I, the doc would have been in the right if he/she thought that the effort would have been futile.

Can you tell me what those states are?

[ukstudent]

I believe that the federal law that gave patients the right to have DNR's also says that if a pt is unable to make that decision then if 2 doctors make the decision that cpr would be futile then they can write a dnr order. I tried looking up which States allow 2 doctors to make this decision even against next of kin's wishes but couldn't find it. I work in DC and this is the law here, I have been told that there are other States that do this as well.

In the OP case only the doctor running the code (respiratory code all day) is needed to call the end of the code, when further effort is futile.

[jojotoo, RN]

I believe that the federal law that gave patients the right to have DNR's also says that if a pt is unable to make that decision then if 2 doctors make the decision that cpr would be futile then they can write a dnr order. I tried looking up which States allow 2 doctors to make this decision even against next of kin's wishes but couldn't find it. I work in DC and this is the law here, I have been told that there are other States that do this as well.

In the OP case only the doctor running the code (respiratory code all day) is needed to call the end of the code, when further effort is futile.

I would be very surprised if the law in DC allowed two (or any number) of physicians to write a DNR on a patient that had no advance directives and that the family did not want a DNR. This just sounds like a lawsuit in the making.

[TiredMD]

I would be very surprised if the law in DC allowed two (or any number) of physicians to write a DNR on a patient that had no advance directives and that the family did not want a DNR. This just sounds like a lawsuit in the making.

You can get sued for anything; ability to sue has nothing to do with what is legal vs illegal.

A physician has the right to hold care that he/she believes is medically futile, regardless of whether or not the patient/family desires treatment. The MD does not need anyone's approval, does not need to consult the ethics committee, and does not need a second physician to sign a piece of paper.

Can he/she be sued for doing this? Sure. But it's perfectly legal.