DNR - What would you do?

Very ill, 50-some year old man, single, no children, few friends, unable to walk, many, many health strikes against him. This patient is VERY ill, and at one point was DNR. Since this admission, code status has been changed to full code. Patient refused nearly all meds, treatments, and cares today. Begged to die. Wants to die. Wants a DNR status. Patient can be confused at times, although at the time of these statements and conversation with physican and sibling POA, patient is lucid and knows where he is, what month/season it is, etc. Sibling asks pt right out "what do you want to do if you stop breathing - do you want tubes to help you breathe?". Pt states "when it's time to go, it's time to go" and continues to restate "no more treatment" and "let me go". DNR order never gets written. False hope given to family members. My hands are tied. What else can I do for this pt? I continue to reassure him that I am there to make him as comfortable as I can and will do all that I can for him...All the RNs on the floor are frustrated as well. Anyone have a similar experience?

Unfortunately yes, this happens all the time. What you can do is be the advocate for this patient, don't contradict the doctors, but explain to the family the difference between extending life (what the family thinks is happening) and extending death (what is actually happening), quality of life, etc. Those things should be easier to understand for the family than the disease processes that they are probably focusing on. Also keep up communication with the doctors and make it clear what the patient's wishes are. Might not hurt to document the patient's communications about his wishes in your note.

You should have an ethics committee in your facility. Time to get them involved.

Gone through this several times. The doctor that we have the most problems with thinks that he can "save" anyone!! You have been given some good advice from the other posters. All I can add is also document, document, document................It is very frustrating as a nurse to have a pt tell you that they don't want anymore treatment and they are ready to die and then have either doctors or family continue to pursue their own "selfish" needs. Makes me sick when I think about it. I have become a huge advocate for Living Wills and DNRs now. Good luck in the future.

Who changed his code status?? I know a Dr needs to give the order for a DNR, but the DR themsleves cannot make the desicion to change the order to a full code can they?? Wouldn't they need the pts permission to change the code to a full from a DNR?? Or did the pt give consent to change the code?? Just a little confused as to why his code status changed. That is a hard situation to be in. I haven't dealt with it from a nurse's point of view before as I am just a graduate, but I worked as a CNA for 18 years and saw this happen to people all the time. It is extremely hard to watch, and to see the family struggling as much as the pt is aweful!! Hope things work out for the gentleman and he has a peaceful passing.

Why wasn't the DNR written? Who's fighting it? It sounds like family is ok with DNR status...?

I deal with issues like this nearly every day I work. Sad to say, but unless you can convince the family that a DNR is what the patient wants and there really is no hope for recovery, then the pt will remain a full code. I try to get them off my unit and to ICU before they actually code on me.

I think it's harder for families to deal when the patient is younger, as is your case. In my case, I coded a 102 year old woman one time with dementia, contractures and multisystem failure. I called the family again as she was coding hoping to talk some sense into them with no luck. They even wanted an autopsy done after she died! The ME talked them out of it, but that was nly because he told them they'd hace to pay for the autopsy, as it was not at all unusual for a 102 year old to die.

Some people just don't get it:wink2: