conflict between pt & son

txspadequeenRN, BSN, RN · Feb 28, 2005

We dont know about what these families have talked about behind closed doors or the agreements made between them. I agree with folowing the pateints wishes. However, the patient did give the POA the right to change ,add or subtract care as he/she sees fit. And the patient knows this upon signing a DNR, it is not my job to deny ,restrict or judge a family or POA for excusing a DNR. I do realize the familys get scared and shaken at the point of the death of a loved one. But instead of refusing them the right to remove the DNR, it is time to have a talk. The majority of the time that is all it takes , a reality check. When they find out what we are about to do to their loved one , bag ,compress and intubate. Things turn around fast. By denying them the right to revoke that DNR you are setting yourself up for a day in court.

i find this incredulous as well as non-sensical. i too work in hospice and have worked with a few pts who were obviously dnr and the family (poa present) wanted it rescinded. I told them that i had to honor the wishes of the patient; and then later i talked with the family how their reactions were normal and i empathized with them. no lawsuits.
but IF this is true in all states, what about pt autonomy and self-will, and a living will? why would anyone allow this to be dismissed as if the pt had no rights whatsoever?
leslie

leslie :-D · Feb 28, 2005

We dont know about what these families have talked about behind closed doors or the agreements made between them. I agree with folowing the pateints wishes. However, the patient did give the POA the right to change ,add or subtract care as he/she sees fit. And the patient knows this upon signing a DNR, it is not my job to deny ,restrict or judge a family or POA for excusing a DNR. I do realize the familys get scared and shaken at the point of the death of a loved one. But instead of refusing them the right to remove the DNR, it is time to have a talk. The majority of the time that is all it takes , a reality check. When they find out what we are about to do to their loved one , bag ,compress and intubate. Things turn around fast. By denying them the right to revoke that DNR you are setting yourself up for a day in court.

the patient knows that the poa can reverse the dnr?

txspadequeenRN, BSN, RN · Feb 28, 2005

Of course they do, it is on the actual DNR form, the revocating provisions I posted before came off the Texas DNR form.

the patient knows that the poa can reverse the dnr?

aimeee, BSN, RN · Mar 1, 2005

but IF this is true in all states, what about pt autonomy and self-will, and a living will? why would anyone allow this to be dismissed as if the pt had no rights whatsoever?
leslie

I don't know if it is true in all states, but it is true in Michigan too:

The order may be revoked at any time by the person who made it, or by her or his patient advocate.

Once you become incapacitated, your POA/medical proxy (if you have appointed one) has been empowered to make decisions AS IF THEY WERE YOU. When you sign that POA, you are giving them them your rights. This is why you must choose your POA wisely and make sure they understand your wishes and will honor them. They are under no legal obligation to do so.

When the POA wants to make a decision contrary to the advance directives, it is often sufficient to remind them that the patient made his/her wishes quite clear and that in accepting the role of POA they made a committment to uphold their wishes. Reminding them that the patient chose THEM to be POA because they believed they would honor their wishes helps them look at it from the patient's perspective.

jerseyRN · Mar 4, 2005

What a nightmare.

I think in most cases CPR would be started as a CYA measure. But it seems to go against intent of the patient.

elkpark · Mar 5, 2005

I worked closely with the legal department of a big teaching hospital when I was doing psych consultation liaison work a few years ago, and this kind of situation came up all the time. Yes, if you have executed a DPOA for healthcare, then, once you are incapacitated or unable to communicate your wishes, the person you have designated is charged with making all decisions regarding your healthcare on your behalf, which could/would certainly include rescinding a DNR order.

However, even if that were not the case legally, most hospitals err on the side of caution and go along with whatever the family members want over what the patient wants -- I have heard hospital legal counsel and administrators comment more than once that the hospital faces a much greater risk of being sued by the surviving family member (for letting Poppa die ...) then they do of being sued by the patient if he actually survives being coded when he didn't want to be ...

bellcollector · Mar 7, 2005

Personally I think it is a shame. What is the point in having a DNR? I understand the need for someone to make decisions for me concerning my medical care for things such as emergency surgery or something like that should I be incapacitated. However if I am in a hospice type of situation or terminally ill I would not want my POA to suddenly panic and put me through all that when the end came.

Chad_KY_SRNA · Mar 7, 2005

At my facility the DNR is usually respected but if the POA is present and requests us to do a full code we must. It usually doesn't make any difference in the end medically. I used to date a paramedic, who had worked EMS for years and never saw a sucessful full code from a nursing home. The family gets a brief moment of hope before the inevitable, the staff is forced to physically violate the resident who they have grown to love. Its bad for all involved.

I was wondering if the OP had this happen, how was it handled?

Blackcat99 · Mar 12, 2005

I just finished my 3 week orientation to hospice. I am shocked to hear that things like this would happen in Hospice. I pray that it never happens to any of my dying patients. Unbelievable!

happthearts · Mar 12, 2005

You know its things like this you almost want to have a small tattoo on your chest over the heart saying DNR .

.If I was terminal I would not want to live .When your do CPR on an older PT you crack chest bones punture lungs and sounds like chicken bones cracking. Then you can end up being a vegetable ..

I have seen 3 families totally rescind a DNR order even after the Pt stated other wise.They should put a law in that if the PT makes that wish it should be granted and no one can take it away.

My husband and I have discussed this he said he would do everything to save me even if I was terminal .I told him how selfish I thought this was .That he wouldn't consider,if I was in pain and maybe needed to go.

Told him if he didn't follow my wishes I come from haunt him when I did go.That this should be my choice.Not my families Because its my life not there's.

When I worked in the Hospital I always asked upon admit did the PT have a living will and or DNR order in place .If they don't understand I explain it to them .If something should happen do you want to have CPR done. Sometimes they ask me what happens durring the process .I am honest and tell them what would could happen and try to stay objective. I tell them they need to make that plan then tell there families what they want.

Chad_KY_SRNA · Mar 12, 2005

There was a man in Western Kentucky who made national news when he had DNR tattoed across his chest just to prevent any confusion. I want to be a DNR on my own complicated criteria that I have in writing for my family. Basically I want a full code for trauma, sudden arrest, illness. If I am ever declared to be in a chronic vegatative or similar state I want to be a DNR.