Can a nurse refuse to participate in a code?

KelRN215, BSN, RN · Jun 2, 2013

What Esme said... I'm in MA too.

DizzyLizzyNurse · Jun 3, 2013

This reminds me of a patient I encountered during nursing school. He was a young-ish man (40s or 50s) with end-stage multiple myeloma in multi-organ system failure. He was in the MICU, intubated, sedated, vented with tubes coming out of every orifice in his body... foley, rectal tube, NG tube. He was a full code. In his chart was a living will which specifically stated "I do not want CPR, I do not want a feeding tube, I do not want a breathing tube, I do not want a ventilator, I do not want to be kept alive by artificial means." (I forget the exact wording but basically everything they were doing to him, his living will specifically said he didn't want.) His siblings were his next-of-kin (he was a lifelong bachelor) and they believed-despite this living will in writing stating he did not want these things- that he "would want everything done." Horrible. That's a patient I would refuse to code and if I was caring for him when the MD ordered the NG tube to be placed, I'd have refused to do that too.

This happens in NY too. I hate it.

squatmunkie_RN · Jun 3, 2013

No way should you be able to do that. It's the patients choice, next of kin's, or medical power of attorney.

squatmunkie_RN · Jun 3, 2013

After reading though the comments, I have to say I'm surprised that some people would actually refuse to do the code. I'm going to follow the law and do whatever it is I'm legally required to do. Do you think the BON would stand behind you if you refused???? HELL NO.

The doc should educate the family, and really it's their choice despite what you believe/know is best.

I remember a pt I had that was in the end stages of respiratory failure. Full Code. He had a trach and was on a Bipap continuously (on a telly floor). He was able to get to the BSC and chair with asst. A co-worker assisted him to the BSC and he just pretty much stopped breathing, I think it was a huge mucus plug, which we were unable to get out through suctioning. O2 sats dropped from 90s...80s...70s..65%..During all this 4 of us literally pick him up and put him back in bed. He's cyanotic and now unconscious. (Did I mention his wife was at the bedside at the time???)

We call a code blue. Then his wife stops us, and says "No no no, it's his time. Just stop everything and let him go." She starts rubbing his cheek and telling him things like "its okay baby you can go now" (at this point all of nurses are getting teary eyed). We cancel the code.

Respiratory is on the floor now and finally they are able to get the mucus plug from the trach. His o2 come back to 90s and he wakes up.

After that the doc and I sat with the wife and he explained how grim things are....they agreed to a DNR and he died about 10-12 hours later.

That was an awful experience for everyone around

PMFB-RN, RN · Jun 4, 2013

After reading though the comments, I have to say I'm surprised that some people would actually refuse to do the code. I'm going to follow the law and do whatever it is I'm legally required to do. Do you think the BON would stand behind you if you refused???? HELL NO.
The doc should educate the family, and really it's their choice despite what you believe/know is best.

*** What will your defence be if you are arrested for battery for coding a patient who did not want to be coded? Do you think "well the doctor, or well the family member told me to" will prevent you from being convicted?

I don't honestly know. I DO know one RN (and some other staff) who was arrested by police and charged with battery for coding a patient who had been clear he did not want CPR or intubation. (he was terrable and constant pain). Despite this the family changed his code status after he could no longer make his needs known. They saved him and the patient was irate and insisted and speaking with his lawyer and the police were called. The came to the nurse's house and placed him under arrest. Lucky for him the patient died a short time later and charges were dropped but he had to live with the possibility of a trial and being convicted for several months.

carolinapooh, BSN, RN · Jun 4, 2013

Nurses can refuse to hang blood based on their own religious beliefs? Really?

Why not? I can't say I'm surprised. Pharmacists have been legally backed when refusing to sell an adult woman Plan B!

carolinapooh, BSN, RN · Jun 4, 2013

*** What will your defence be if you are arrested for battery for coding a patient who did not want to be coded? Do you think "well the doctor, or well the family member told me to" will prevent you from being convicted?
I don't honestly know. I DO know one RN (and some other staff) who was arrested by police and charged with battery for coding a patient who had been clear he did not want CPR or intubation. (he was terrable and constant pain). Despite this the family changed his code status after he could no longer make his needs known. They saved him and the patient was irate and insisted and speaking with his lawyer and the police were called. The came to the nurse's house and placed him under arrest. Lucky for him the patient died a short time later and charges were dropped but he had to live with the possibility of a trial and being convicted for several months.

To this day I DO NOT understand why this is okay, permitted, allowed, and legal.

Why have an Advance Directive or a self-defined, self-executed DNR if everyone else is allowed to speak on your behalf??? (Rhetorical question, but I think you get my intent.)

anotherone, BSN, RN · Jun 4, 2013

You have to do a lot of things as a nurse you don't think are ethical or morally okay. No one cares what you think but you will have to live with doing those things and come to terms with them.

anotherone, BSN, RN · Jun 4, 2013

KelRN215, that's just despicable. The siblings can't read? Why did the MDs go against the patient's living will? Did they try to communicate to the sibs that his living will was very specific? I don't see how there could have been any confusion there. It's just horrible.

I don't even work in ICU and I have seen this happen all the time.

Jory, MSN, APRN, CNM · Jun 4, 2013

They can call 911. They can go to the hospital. But it states we as hospice nurses do not perform CPR. It's there.

How unfortunate. That surprises me that any patient/family member would agree to that.

Jory, MSN, APRN, CNM · Jun 4, 2013

To this day I DO NOT understand why this is okay, permitted, allowed, and legal.
Why have an Advance Directive or a self-defined, self-executed DNR if everyone else is allowed to speak on your behalf??? (Rhetorical question, but I think you get my intent.)

This has always surprised me as well, because I can assure you, if I had a self-directed DNR and someone decided to override it (be it MD, family or anyone else), whether I'm a nurse or not, I am going to pursue every legal avenue for a lawsuit, go after their professional license, etc.

Absolutely nobody, should have the authority to override a living will that was executed by the patient.

Good Morning, Gil · Jun 4, 2013

Interesting question, but we're obligated to help in a code. If there's adequate staff, you could step aside, but if the person is a full code, even if you think it unethical for them to be so, it would be deemed failure to rescue if you didn't, well, in a word, rescue. It's something we encounter in the ICU, and we do our best to have the MD initiate that discussion before it comes to that, a code, but sometimes the right, or ethical, decisions don't get made by families, and there's not much we can do about it other than consult ethics, palliative care, and hope that many people talking to them help them see the futility of it all.