DNR Orders Overturned By Doctors

[DaFreak71]

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.

[CHATSDALE]

the problem frequently is that the NOK, RP POA may be diiffent with one person in one position sometimes the doc and the hospital don't know whose word is legal

if the patient is unable to make a decision for themselves siblings can be angry and refuse to listen to each other

if these are step siblings it throw gas into the fire

if a doc is going to err he really doesn't have much choice except to err on the side of doing full code

and the procedure known as a slow code has no legal standing at all

[DaFreak71]

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.

Wow, that is sad! I'm glad that your dad eventually had his wishes respected, but sorry that you had to go through the angst to enforce them. I honestly don't understand why hospitals go through the bother of asking patients if they'd like to have someone talk to them about a living will if it is so susceptible to being overturned by a family member who thinks mom will suddenly pop out of her persistent vegetative state after five years.

My husband and I made a pact, that if either one of us comes down with something terrible (Alzheimer's, incurable cancer, CVA that leaves us drooling and useless, etc) we will divert enough morphine to end the others suffering. Consequences be damned. But I digress...

[woody62, RN]

If a patient has a properly notarized Living Will plus a duly appointed health care proxy, woe be it for any physician to disregarding a patient's wishes. Anyone can sue. It doesn't mean they will be successful. And if there is an appointed health care poxy and tells the physician to make the patient a DNR, as long as it is also accompanied by the Living Will stating the patient's wish, the physician can't change the desire. I have had a detailed living will since the 80's when it really wasn't viewed as a legal wish. I have had a health care poxy since the 90's. And my PCP knows my wishes, has agreed to them, has a copy of my Living Will and health care poxy. Woe be it to him to ignore my directions. And he knows it.

Woody:balloons:

[FireStarterRN, BSN, RN]

I think the humor might have been a lame attempt to compare this flipflopping to John Kerry's political flipflopping. The joke was, however, a flop without a any flip. Just like George Bush.

[FireStarterRN, BSN, RN]

I think the humor might have been a lame attempt to compare this flipflopping to John Kerry's political flipflopping. The joke was, however, a flop without a any flip. Just like George Bush.

See, two can play at this game...:balloons:

[nursejane236]

Had a 22 year old end stage dialysis patient that was waiting for transplant and was a DNR living at our facility. Patient was competent and signed her own DNR. Mother came to visit from Germany and patient collapsed. Mother who was POA screamed to begin CPR which of course was done. EMT's arrived saw the DNR and stopped the code despite the mother's POA. EMT's acted as if we did something wrong and while in the hearts of many it too felt that way, the mother as listed POA was calling the shots.

[cmo421]

I think the humor might have been a lame attempt to compare this flipflopping to John Kerry's political flipflopping. The joke was, however, a flop without a any flip. Just like George Bush.

Actually I think it was the op just venting and got carried away, as most of us have and do when we r passionate about something. I think we should all play nice .

[LSWgirl]

In Maryland, the EMS workers could have called the police and the facility can be cited for coding a person with a DNR order. I know of a facility that was closed because of this. It's considered assault and battery.

The doctor will always be legally right if they follow a living will. In fact, in our facility, we have to follow the living will and POA no matter what. I once had to meet with my administrator, the DON, and a family member/POA to pull a g-tube on demented patient because his living will said no artificial nutrition and hydration, the son had it placed in the hospital, and he came back to our LTC facility with it.

Maryland is tougher than a lot of states, and the ramifications for not following a living will are huge. The doctor is safer to err on the side of the living will.

In the OP though, it didn't say there was a living will. In that situation, the family can do whatever they want. *Sigh* It's heartbreaking when they do that, though.

[Crash_Cart]

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.

You know, John Kerry = Flip, Flop ...get the connection ?

Sheesh.

DNR = Flip, Flop policy that changes like the weather outside changes.

...Please don't ask me to explain the weather outside reference. It's too complicated. :)

My Best.

[FireStarterRN, BSN, RN]

You know, John Kerry = Flip, Flop ...get the connection ?

Sheesh.

DNR = Flip, Flop policy that changes like the weather outside changes.

...Please don't ask me to explain the weather outside reference. It's too complicated. :)

My Best.

Previously it was George Bush Sr who was a notorious flip flopper, now that we are scandalously off topic. You might be too young to remember "Read my lips, no new taxes".:lol2:

[caroladybelle, BSN, RN]

You know, John Kerry = Flip, Flop ...get the connection ?

Not any more so than, oh say virtually any other politician, conservative or liberal, most of whom can be cited as doing the same thing, as often or more so, even when they complain about it in others. And I still don't get where it has anything to do DNRs. Nor what was humorous about it.

Would it not be more accurate to just say "flip-flop" or "changeable" , something that does have a clear meaning, and has no inherent bias to a certain mindset. Given that we are talking about a medical issue such as DNRs..an important topic that deserves attention on it's own.

[FireStarterRN, BSN, RN]

I wish George W Bush would flip flop a little bit.