My question is, how can the family come in and reverse a decision that the patient made when he was alert and oriented?
Here's the story....
I'm an ER nurse and I took care of this patient when he first was brought to the ED via rescue c/o SOB. He was, of course, admitted to hospital. About a month later, by coincidence, I was working when the hospice floor called the ER and wanted to transfer a patient to the ED because he rescinded his hospice care and he ended up being my patient again.
The patient - late 80s, A&Ox3 male had end stage lung cancer, which according to his doctor was quite aggressive. Like I said, he was my patient before and he was totally with it and capable of making his own decisions. After being admitted to hospital, he signs himself into hospice after a discussion with his PMD and signs a DNR.
After being in hospice for approx a month, he became my patient again, except this time he was not responsive at all, not even to pain. Also, this time around several of his relatives were there and were accusing the hospice nurses of being inhumane. Of course, I called the hospice unit and asked them what was going on with this patient. She said that over the month, the patient was starting to decline. He was eating/drink less and then eventually not all, he started to become less and less responsive. The relatives wanted IV fluids to be started since he wasn't drinking anymore. She said the relatives were doing this all afternoon when finally one of the them says that she wants him transferred off the hospice unit. They called the PMD, but he said he couldn't do anything because the patient signed himself into hospice when he was alert and oriented, although he is not anymore. This is when we get a call in the ED that the patient rescinded his hospice care and is being transfered to ED so he can be admitted to regular room, as a FULL CODE!
I asked how this patient was able to sign himself out if he isn't responsive, he didn't even flinch when I put an IV in his arm. She said it was the family's decision and they "forced" him to sign the paper. So, in the ED we drew blood, started him on IV fluids and treated him as a full code.
Any input to help me understand how this is allowed would be appreciated because this really upsets me. I was under the impression that we are supposed to honor the patient's wishes regardless of what the family wants. I feel like my hands are tied on this one since no one involved seems to think any differently.
Well, per Betsy McCaughey(sp?)....who was one of the sources behind the "death panel" allegations, she feels that MDs should not be rated on whether they abide by a patient's living will/advanced directive.
She comments that pts may change their minds, ignoring the fact that if a pt is capable of changing their mind, that invalidates the living will/advance directive.
I personally feel that we should have it available to us as consumers whether an MD abides by a person's living will.
the family's wishes supercede the patient's wishes. if the family says do CPR, we do CPR, regardless of what the patient had requested on paper.
this isn't ethical but families will sue on a drop of a dime. We do what they want
we are patient advocates! we have written documentation that states clearly the wishes of the pt. here's how you solve the ethical issue: fight with the family until the pt passes.
caroladybelle, BSN, RN
5,486 Posts
Well, per Betsy McCaughey(sp?)....who was one of the sources behind the "death panel" allegations, she feels that MDs should not be rated on whether they abide by a patient's living will/advanced directive.
She comments that pts may change their minds, ignoring the fact that if a pt is capable of changing their mind, that invalidates the living will/advance directive.
I personally feel that we should have it available to us as consumers whether an MD abides by a person's living will.