DNR Orders Overturned By Doctors

Nurses General Nursing

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Hi,

I am a nursing student and my husband is a RN in an ICU. He tells me that a patient will come in as a DNR and then the patients family will talk to the doctor and then the doctor will change the patients code status to full code.

Why do you think this happens? It's my understanding that if the patient wanted to be DNR, this should be respected regardless of how the family feels about it. Doesn't the doctor have a legal responsibility to respect the patients signed DNR order?

Do you think this happens because doctors don't want to have a confrontation with the family and it's "easier" to comply with the families wishes rather than have the family feel as though the doctor is "letting" the patient die?

My husband tells me that a lot of the patients in the ICU are from nursing homes, have severe dementia and are bed bound, with minimal to no LOC. It seems sad to me that they are being kept alive on ventilators against their documented wishes.

Is this legal? Is it ethical? Is it prevalent in your experiences as RN's? Or is the hospital my husband works at the exception?

Thanks for any feedback you are able to offer. I'm just sort of baffled by this issue. :o

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I think it's to avoid being sued.

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Specializes in ED, ICU, Heme/Onc.
Hi,

I am a nursing student and my husband is a RN in an ICU. He tells me that a patient will come in as a DNR and then the patients family will talk to the doctor and then the doctor will change the patients code status to full code.

Why do you think this happens? It's my understanding that if the patient wanted to be DNR, this should be respected regardless of how the family feels about it. Doesn't the doctor have a legal responsibility to respect the patients signed DNR order?

Do you think this happens because doctors don't want to have a confrontation with the family and it's "easier" to comply with the families wishes rather than have the family feel as though the doctor is "letting" the patient die?

My husband tells me that a lot of the patients in the ICU are from nursing homes, have severe dementia and are bed bound, with minimal to no LOC. It seems sad to me that they are being kept alive on ventilators against their documented wishes.

Is this legal? Is it ethical? Is it prevalent in your experiences as RN's? Or is the hospital my husband works at the exception?

Thanks for any feedback you are able to offer. I'm just sort of baffled by this issue. :o

Well, your husband is right. Sad to say, but even the most eloquently written, legally notorized living will means nothing when you are intubated and your power of attorney or next of kin yells "DO EVERYTHING" to the doctor over your inert form. You can only hope that cooler heads prevail after the inital shock of the patient's illness wears off. Which is what happens most of the time. But only after a few days of being held captive in the ICU intubated and sedated on the vent!

Blee

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.

The doc is damned if he does and damned if he does not. Just one family member saying do all is enough for most to back off the DNR. But if the pt recovers and finds out they were resusitated when asked not to be, the doc can also be sued. Ethic committees are great for helping out here. I have seen doc take the chance and follow the pt's wish,especially if they had talked to the pt themselves at some point. If the DNR is signed,witness,specific to detail and legal, then Doc's really should adhere by them no matter what.Documention is key in all these cases.

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I spent almost $1000 to have my documents drawn up. Recently I required emergency hospitalization for surgery, and other doctor visits. In each case, my power of attorney was refused, therefore I was told that my wishes would not be followed. I was in no condition to shop around and find someone who would comply with my advanced directive. Just an example of what a worthless document it can turn out to be. So much for patient's rights.

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When it comes to listening to the family members vs pt wishes on issues of DNRs/organ donation ect. I heard a good saying once...

"Dead people don't sue....it's the ones still alive that do"

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Specializes in ER OR LTC Code Blue Trauma Dog.

When you leave such decisions to non medical/nursing decision makers to implement DNR policies, then such policies have absolutely no medical value whatsoever. In 2007, a DNR pertains to the idea that it' a legal matter.

DNR's have mostly become a family emotional and potential legal rights issue rather than a bonafide medical decision as it probably should have remained in the first place.

Incidentally, DNR's are not written in stone but they usually trump living wills. After all, who really care's what the patient really want's anyways? Dang it, we are trying to avoid a potential lawsuit here!

Technically speaking this means a DNR may be subject to change on the fly, every minute of every hour and as circumstances warrant. Technically speaking this means a DNR order might change between the intstant you read the doctors orders and the moment you initiate CPR on a DNR pt. so be careful. :)

It's just another flip, flop policy developed by the John Kerry school of nursing administration to create "organized confusion" in the nurse's workday. I suppose it could take up to 30 minutes or so to track down the pt chart to check the "latest DNR status" and then you wouldn't have to worry about calling a code anyways.

:)

My Best.

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Specializes in Med-Surg, Wound Care.
When it comes to listening to the family members vs pt wishes on issues of DNRs/organ donation ect. I heard a good saying once...

"Dead people don't sue....it's the ones still alive that do"

Which absolutely defeats the whole purpose of a living will. So why are we dancing through hoops to provide information to patients on the living will if a doctor or family member can totally disregard it's presence???

This is a BIG point of contention with me. I fought to have my father made a DNR, I fought to change his status to comfort care(I was medical power of attorney). His doctor would have treated him on the way to the funeral home if I let him. It was horrendous! I KNEW my fathers wishes and was going to carry them out. I finally had a showdown with the doc and told him if he wasn't "comfortable" with dealing with end of life issues, then he could transfer my fathers care to another doctor. My Dad died peacefully 12 hours later, NO tubes, no code and with dignity. But it wasn't without ALOT of angst for the whole family.

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Specializes in Oncology/Haemetology/HIV.

It's just another flip, flop policy developed by the John Kerry nursing administration to create "organized confusion" in the nurse's workday.

Exactly what is that supposed to mean?

As far as I know, there is no "John Kerry" involved in this conversation. The only "John Kerry" that I am familiar with is in politics, and this is clearly not a thread where he is involved.

Could we please leave the political sniping to the appropriate forum, as there is one set aside for that purpose? This is not the place for unrelated political name-calling at each other - it is rude, annoying and uncalled for in this forum.

Carolina (not a Kerry supporter nor a supporter of ANY political party)

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Specializes in ER OR LTC Code Blue Trauma Dog.

I think we all have a right to openly express our opinion on the current topic of DNR policies. Using political humor as a mode of comparison to get a particular point across is not an unreasonable assumption in my view. No political name calling has taken place.

Sorry if this should offend you or anyone else for that matter.

My Best.

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Actually, the whole statement confused me. I have no idea what you mean as it pertains to this discussion.

As far as family revoking DNRs and Living Wills, I've seen it happen way too often. People need to be educated better about what it all means and that it doesn't mean we aren't going to treat their loved one if necessary. Unfortunately at the end of a loved one's life is not the best time to do the educating.

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Specializes in Oncology/Haemetology/HIV.
I think we all have a right to openly express our opinion on the current topic of DNR policies. Using political humor as a mode of comparison to get a particular point across is not an unreasonable assumption in my view.

Sorry if this should offend you or anyone else for that matter.

Please explain the humor...I didn't comprehend it...and I am usually quite good with that? I also don't see how the reference had to do with DNR policies.

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