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.

[TiredMD]

We actually just went over this in NS, and we were told that a DNR is null and void if ANY immediate family member says, "save them" (or anything of the like). I think it's horrible that a persons wishes can be overturned like that, but unfortunately it's the law (according to our nursing instructors).

Oh my God, I hope you didn't believe that.

[elthia]

Woody, I'm sorry, but this post, like several of your other posts regarding other government benefits, reflects the "letter of the law" but does not take into account the countless ways that people live within the system or subvert the system every single day.

People live together and support each other financially in every imaginable way. Family or significant others may well agree to live together or otherwise financially support each other with the full knowledge and agreement of the SSI recipient. And at the other end of the spectrum, people certainly do unfortunately rip off the vulnerable elderly. I have an elderly relative, an SSI recipient, for whom I provide care. We have a joint checking account in both our names into which her social security check is direct deposited. All I would have to do to use her SSI money would be to write myself a check out of our joint account. You are assuming that the only way that a family member, friend, significant other, etc. could access an SSI's funds would be to have a form witnessed, etc. ... and it just ain't so.

Oh, and if grandma is alive on September 30, that check will be deposited on October 3. Maybe Grandma's relatives are despicable money-grubbers ... or maybe they're just trying to make sure the rent can be paid on the apartment they all live in. It's the following deposit, on November 3, that would have to be paid back to SSI.

My father lived with family....and he died in the middle of the month. The Department of Veteran's Affairs sued me and my siblings for a refund of his benefit checks for the month in which he died and the prior month(this money had already been spent). This was after he had been turned down for social security, had his life insurance cancelled,etc.

And now I have to pay taxes on the measly $3000 from an old 401K that I inherited that I am using to help pay for his funeral expenses. Gotta love the government.

[elthia]

We actually just went over this in NS, and we were told that a DNR is null and void if ANY immediate family member says, "save them" (or anything of the like). I think it's horrible that a persons wishes can be overturned like that, but unfortunately it's the law (according to our nursing instructors).

I think that may depend upon the state.

I know in some states EMS do NOT have to honor an Out of Hospital DNR.

[Scrubby]

I strongly believe that if a patient is DNR and they are resuscitated against their wishes then that's a case for assault and battery. I think that more needs to be done to ensure that once a DNR order is in place, in stays in place unless the patient indicates they wish for extraordinary measures.

It's very hard to respect the relatives who seem to only care about themselves, not the person dying and in pain.

I can remember being on the ward and we had a patient who was palliative care, DNR and end stage renal disease. She was an elderly lady who didnt' really rouse at all, she just lay there dyingl. Her daughter who was a physiotherapise came in and actually managed (behind closed doors) to get this patient out of bed, and in a chair. It was horrendous because the patient was completely out of it, and the relative was holding her up shaking her and yelling at her. I came in and i came close to screaming at this woman to leave her poor mother alone! In the end i grabbed another nurse and we got this poor lady back into bed with the stupid daughter protesting. I told her firmly that from now on the door stays open and i will call security if you try and do that again. I could not believe such cruelty.

She threatened to sue us all if we didn't perform CPR and tried to get the docs to overturn the order. Thankfully the order stayed in place and the lady died peacefully later on.

I understand it must be hard for some ppl to watch relatives die. But there are some families out there who just make me want to kick them out of the hospital!

[TiredMD]

I know in some states EMS do NOT have to honor an Out of Hospital DNR.

Very true. Out of hospital is quite a different situation than in-hospital. For example, in one state I worked in, EMS was obligated to full code any patient unless they had a state-issued bracelet attesting to their DNR status. Even a written Advanced Directive was insufficient, they had to have the bracelet. I won't even tell you the hoops docs had to jump through to get the bracelet for their patients.

Stupid, of course.

In my current state, all that is required is a form signed by a physician confirming their DNR status.