conflict between pt & son

Trauma Columnist · Feb 27, 2005

At least in Illinois, we would be doing everything. However, I would contact pastoral care immediately to help sort things out.

leslie :-D · Feb 27, 2005

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 dnr's can be rescinded at any time.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.

jnette, ASN, EMT-I · Feb 27, 2005

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 dnr's can be rescinded at any time.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.

leslie :-D · Feb 27, 2005

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.

KarafromPhilly · Feb 28, 2005

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?

leslie :-D · Feb 28, 2005

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

happthearts · Feb 28, 2005

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.

txspadequeenRN, BSN, RN · Feb 28, 2005

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 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?

leslie :-D · Feb 28, 2005

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

txspadequeenRN, BSN, RN · Feb 28, 2005

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 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

leslie :-D · Feb 28, 2005

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