conflict between pt & son

  1. Mr x is admitted for pallative surgury. PT has a living will, durable power of attorney and A DNR. Son is his durable power of attorney. Pt collapses on way to bathroom, no pulse or respirations. Son tells nurse to do everthing possible for PT. What should nurse do? Honor the DNR or the durable power of attorney's request. Any comments would be appreciated. thanks
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  2. 22 Comments

  3. by   traumaRUs
    At least in Illinois, we would be doing everything. However, I would contact pastoral care immediately to help sort things out.
  4. by   leslie :-D
    Quote from dragon5282001
    Mr x is admitted for pallative surgury. PT has a living will, durable power of attorney and A DNR. Son is his durable power of attorney. Pt collapses on way to bathroom, no pulse or respirations. Son tells nurse to do everthing possible for PT. What should nurse do? Honor the DNR or the durable power of attorney's request. Any comments would be appreciated. thanks
    nurse should perform cpr and call 911. dnr's can be rescinded at any time. so it's the poa's call.
  5. by   jnette
    Quote from earle58
    nurse should perform cpr and call 911. dnr's can be rescinded at any time. so it's the poa's call.

    Leslie.. the DNR can be rescined at any time by WHOM ??? Please clarify.
  6. by   leslie :-D
    Quote from jnette
    Leslie.. the DNR can be rescined at any time by WHOM ??? Please clarify.
    by either competent pt or the poa. people can change their minds at any time.
  7. by   KarafromPhilly
    I would think that if the patient specified that they wanted to be a DNR when they were competent to make that decision, then the DNR would stand. Even if the son is the POA, he doesn't have the right to overrule the decision his father made for himself. Otherwise, the father's right to decide for himself would be meaningless. IMHO, the son panicked--if not, why didn't he rescind the DNR earlier?
  8. by   leslie :-D
    Quote from KarafromPhilly
    I would think that if the patient specified that they wanted to be a DNR when they were competent to make that decision, then the DNR would stand. Even if the son is the POA, he doesn't have the right to overrule the decision his father made for himself. Otherwise, the father's right to decide for himself would be meaningless. IMHO, the son panicked--if not, why didn't he rescind the DNR earlier?
    that's true-if the pt stated he wanted to be a dnr and it's in writing, then the son/poa cannot supersede that.

    leslie
  9. by   happthearts
    Quote from earle58
    that's true-if the pt stated he wanted to be a dnr and it's in writing, then the son/poa cannot supersede that.

    leslie
    My understanding is if any family member is there at the time of death They can resind that DNR order at any time. Had a family member do it,Here in Utah made us take PT to the hospitial where she lived though the heart arrest .PT lived one more year until she died .When family was better then to accept the death.Too bad just about wiped her whole estate out.
  10. by   txspadequeenRN
    This is not true, the medical POA calls the shots. He can cancel a DNR just as easy as he can sign one for the patient.






    Quote from KarafromPhilly
    I would think that if the patient specified that they wanted to be a DNR when they were competent to make that decision, then the DNR would stand. Even if the son is the POA, he doesn't have the right to overrule the decision his father made for himself. Otherwise, the father's right to decide for himself would be meaningless. IMHO, the son panicked--if not, why didn't he rescind the DNR earlier?
  11. by   leslie :-D
    Quote from txspadequeen921
    This is not true, the medical POA calls the shots. He can cancel a DNR just as easy as he can sign one for the patient.

    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
  12. by   txspadequeenRN
    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.






    Quote from 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
    Last edit by txspadequeenRN on Feb 28, '05
  13. by   leslie :-D
    Quote from 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
  14. by   txspadequeenRN
    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.




    Quote from 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

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