DNR's that do not mean a thing!! Help...

springchick1, ADN, RN · Oct 17, 2013

It may be the parent/child/sibling or whoever has power if attorney and can make all medical decisions for the patient.

kati.corirossi · Oct 17, 2013

Right, but I was under the impression that those who are not the power of attorney were still making the decision to keep a loved one alive against their will.

akulahawkRN, ADN, RN, EMT-P · Oct 17, 2013

May have to do with state law. It could be that in your particular state, anyone's allowed to contest the validity of the DNR, and therefore effectively nullify it.

Esme12, ASN, BSN, RN · Oct 17, 2013

As brutal as it sounds......because only the living can sue.

Not all states recognize living wills as a legally binding document.

krisiepoo · Oct 17, 2013

That's why it is important to discuss your wishes with your family ahead of a crisis. I have a healthcare directive and have talked to my doctor about my wishes but in the end nothing matters if everyone is on the same page. Talking about death is scary for some people so people tend to avoid it until it's too late.

I used to be a case manager and would do healthcare directives for people and instead of just filing it, we sent copies to the healthcare agents and then did phone calls/meetings to discuss the ramifications/desires of all involved.

HouTx, BSN, MSN, EdD · Oct 17, 2013

From a nursing standpoint, there are no real consequences for disregarding a DNR - but there ARE real consequences for disregarding a physician's order, even when he is acting in opposition to the patients expressed wishes. This is an instance when the Ethics Committee is our best friend. Every nurse should know how to contact them, they are a wonderful resource and have the "power" to override physician opinions in favor of the patient's wishes.

hodgieRN · Oct 17, 2013

If a pt has signed a DNR, it's the health care surrogate's responsibility to care out and respect the DNR when the pt becomes incapacitated. They are supposed to carry out the wishes of the pt and respect their rights. We will get a consult with palliative care and have them talk to the family member who is having a difficult time.

Now, I can see the line being a little grey if the health care surrogate initially signed the DNR for the pt (maybe b/c things were going down hill) and then rescinded it. But if a pt has signed a DNR on their own free will, I don't really see doctors ignoring the DNR when a family member speaks up when things are starting to happen. I think disregarding a DNR does have consequences. It violates the rights of the pt. Maybe their should be law suits against family members who ignore a pt's rights and put their loved ones through futile torture.

nurseprnRN, BSN, RN · Oct 17, 2013

There's a very famous case in the law and medicine arena. Mrs. Candura in NJ was an elderly diabetic with a gangrenous leg. She refused surgery. She completely understood that if she didn't have it off she would die from it, and said she was ready to die. Her physicians agreed not to amputate because that was her wish. After a time she began to fail (die), and was not longer alert and oriented. At that time her daughter went to court to compel her mother's physician to amputate the leg to save her mother's life. The court refused to so order, saying, in effect, it would be unconscionable to know what her wishes were and then wait until she could no longer defend herself against unwanted medical intervention, in this case, amputation. I guarantee that of your hospital ethics committee members, at least one is familiar with that case.

kati.corirossi · Oct 28, 2013

I appreciate all of your responses. GrnTea, I had never heard of that case. Thank you for sharing it! :) Hou Tx, I knew that there was some help out there when a breech of ethics arose, although I was unaware that there was an ethics comittee just a phone number away. I will have to find out how to contact our ethics commitee at the hospital I am training with. Esme12, you are so right!! Only the living can sue! That's so true. And unfortunately these days people are so sue happy, and healthcare tries to avoid being sued at all possible. It's a sad deal.

kati.corirossi · Oct 28, 2013

I actually had a Pt recently whose code status changed from full code, to DNR/DNI, back to full code, and then back to DNR/DNI within just a week!!! The Pt was confused and unable to speak for themselves. The family was fighting against each other to chanch the Pt's code status, but finally the issue was resolved and the husband who was the Pt's power of attorney had the final call as making the Pt a DNR/DNI after a long discussion with the MD. It was a mess.

PMFB-RN, RN · Oct 28, 2013

Hello all! So throughout my nursing student experiences we have all wondered why a patient can sign a DNR as their wish but family members can speak up and say "Save my mother!" and the nurses and doctors will then listen to the family and try to save that family member. So why is that does anybody know? I do not get why somebody can make it their wish to not be resuscitated and then someone else's say can trump the patient's wish. Thank you to all who read and reply. I am very interested in hearing everyone's reply.

*** Well first of all I don't do that. I have refused to code more than one patient who I knew did not wish to be coded in spite of the families wishes. None of us should be coding and patient who has made the decision to be a DNR.

The answer why it happens is very easy. As explained to me by a crusty old ER physician "Dead patients don't suit, living families do"