One thing I've had a really hard time with ethically, especially in the past few months, is when an alert, oriented, informed, patient is admitted- usually a COVID patient- and makes themselves a DNR/DNI. Then, as they become hypoxic and hypercapnic, confusion can set in. We have had MULTIPLE times when family members step in and change that person's code status to full code, and they have been intubated. Most of them die, after an awful intubation course. But we've had a couple make it. One in particular is trached, pegged, and miserable. He constantly pulls things out, Foley, PEG tube, central line, and recently, he purposely threw himself over the bed rail onto the floor. He does not want any of what he's enduring and now he's stable and there's nothing we can do.
I've considered contacting our ethics committee members to see what their guidance is on this issue. It seems that defensive medicine will always win, a dead patient can't sue us, but the dead patient's family members can. So, we ignore the wishes of a patient and acquiesce to the family. In one particularly horrifying instance, we had a patient admitted who stated she had a living will. She had also named her daughter as the health care proxy. The daughter refused to bring in the living will and made her mother a full code until she basically rotted away on the vent. Her family members were furious because they knew it wasn't what the patient wanted. The ethics committee was called about that situation, but they don't meet often so it wasn't addressed before the poor woman lingered for almost a month on a vent before dying.
It's bad enough that all these people are dying, but to know that some of their suffering could have been avoided, per their OWN wishes, is just infuriating.
