Full Code required for surgery?

See that makes sense, but requires a HCP to follow up. We've had to fight our MD's before to resume code status.

It does kind of make sense.

The salvageability of a pt in surgery is very different than in a LTC.

AFAIK, a brief code with full recovery is not all that unusual. And to have somebody go to surgery, then prevent the surgeon or anesthesiologist from rescuscitating doesn't make a lot of sense.

But, on return, when it starts becoming obvious that Grandma won't be making it home for Christmas, their wishes should be honored.

What about palliative type surgeries?

I had a patient whose pre op note prior to undergoing a debulking for pain relief literally stated that it would be merciful for the patient to die under anesthesia.

Nope, they don't automatically lose their ability to make any other kind of treatment decision. No one's really been able to explain it to me in any way that makes sense.

It's hard even for "thinkers" to make sense out of these things because too often the rationales given to nurses are just someone's idea of something; rarely do we get the benefit of knowing how/why a legal or ethics committee came to the conclusion. And worse, we often get a superior's "take" on it (or their own emtional reasoning). I do not know the answer to this one but I think (right or wrong) it goes something like this:

We know that we allow LEOs to compel the person who expresses suicidal ideation/intention to present for evaluation. They legally can take people into protective custody and present them for evaluation. At the hospital, we can legally compel you to stay until we evaluate your situation. We also know that we hospitalize patients (sometimes involuntarily) because they have verbalized an intent to kill themselves. So, our legal system does support this idea that we as a society have an interest in trying to prevent people from killing themselves, and when we are aware of their intent to do so we legally take steps to prevent them from doing it - steps that can be considered fairly extreme if necessary (involuntary hospitalization).

If we have a suicidal patient in the hospital, we will enact precautions to prevent suicide attempts while hospitalized. Why do we do that - well (aside from the obvious liability issues), we do it because we have a societal value that we should do all we can to prevent people from voluntarily killing themselves, especially when we haven't had the opportunity to thoroughly assess judgment and insight or provide any assistance or rule out medical issues that may be contributing. All that to say that when no measures have been taken in attempt to determine whether the decision (to kill oneself) is being made in a sound state of mind, we (legally) make attempts to stop them from doing it.

The person who has already made the attempt and now is being presented for resuscitation is a bit of a different situation than a patient who presents for care in a suicidal state, but it seems like similar principles of care are applied (we will do what we can to not let you succeed with your intent to kill yourself) - - I am making no declaration or judgment about the correctness or incorrectness of this, I'm just saying I think these are some of the underlying ethical and legal points that an ethics committe would consider, and that probably have something to do with 'all patients who attempt suicide are full code.'

Right or wrong, I think the reason that we don't honor a DNR when one is found in extremis following suicide attempt is because we also don't/wouldn't legally "honor" your statement that you want to die when you are alive. Instead, we take direct actions against it. The laws of our society still support the idea that we can compel you for a mental health evaluation and take measures to ensure that you don't kill yourself up to that point.

The only surgery for which I've seen full code required for us is open heart. Otherwise, as far as I know, patients stay DNRs.

Nope, they don't automatically lose their ability to make any other kind of treatment decision.

I respectfully disagree. To my knowledge, most if not all patients who have attempted suicide are placed on a psychiatric hold. That in and of itself is a loss of their ability to make decisions. They are not allowed to refuse admission or demand discharge.

Once admitted, they may refuse medications, treatments and therapy, but to my knowledge, there is no treatment decision other than a DNR that could predictably result in the patient's death.

JKL33's explanation is far more elegant, but I believe s/he and I are essentially saying the same thing.

Correct, there are no DNR/I in the OR, its suspended until I believe Post op day 3 but don't quote me... lol I work in the OR, all I know is that there is no such thing as a DNR

Every patient is a full code in the OR/- a DNR is temporarily suspended

They lose their right to choose to leave the hospital and to refuse admission to a psychiatric facility if that is deemed necessary by the psych people who evaluate them after admission; however, as I stated (and as you stated), they don't automatically lose the right to make decisions about their treatment while in the hospital (or in a psychiatric facility -- the involuntary commitment laws only legally compel people to be detained for evaluation; they don't require that people participate in the evaluation, or permit people to be treated against their will without further legal proceedings).

Involuntary commitment is intended to prevent the individual from ending his/her life (among other goals.)

If a suicidal patient is not admitted, there is a high risk of death.

If a suicidal patient is allowed to demand discharge, there is a high risk of death.

If a suicidal patient is allowed to elect DNR status, there is a greater than "normal" risk of death, in part because even in a protective environment, some patients will find a way to inflict serious harm to themselves.

For this reason, it makes sense to me that disallowing DNR status of a person on a suicide hold is an extension of involuntary admission and not denial of treatment decision making.

I may just have to agree to disagree on this point.