Wow. I have been on so many sides of this in my career. I've had two nursing home patients in different hospitals who were intubated against their wishes, one because the EMS in that community *routinely* intubated all the "found down" patients they were called for (this was a long time ago), the other because the nursing home conveniently "couldn't find" the patient's DNR orders and she had no family to confirm them (her pastor was POA and out of town). In both cases those were two of the angriest patients I ever saw. The first had her ET tube removed once the doctor saw her paperwork and confirmed with her that she was indeed a DNR; she was pretty much in her right mind and was mad as hell. She lingered for a few days and expired peacefully on the med-surg floor. The other was kept in the ICU on the vent until her doc returned from vacation, which IMO was criminal. I had her the day he returned and she glared at everyone, especially the RT when he came in--such venomous looks! I sang to her when I was in her room, mostly hymns and spirituals, and she softened up a little for me. When the pastor finally came in that afternoon, he asked her if she really wanted to be removed from the vent and if she understood that being removed meant she would not be able to breathe on her own for long and would die. She nodded vigorously. I called the attending, he came in and wrote the orders and the RT came to remove her---and got one more nasty look for his pains, until she realized what he was doing. Once the ET was out, she relaxed for the first time all day. I sang "Steal Away" and she smiled at me and closed her eyes. She died quietly about a half hour later.
When my 91 year old home health patient had what I was almost certain was an MI and refused to go to the hospital, I called her doctor and explained the situation. He wanted her to go to the ER, but she continued to refuse. I explained this to him and he said, "But she'll die!" and I said, "Dr. F, she's 91 years old, and she's tired. I don't think we can *make* her do anything." He was very quiet for a minute and then gave me some orders that made pretty good sense, comfort care, etc. The patient stayed at home and a couple of months later had "the big one" and died in her own bed where she wanted to. I found out a few weeks after the phone call that the doctor was on the list for a liver transplant (Hep C) and so was grappling with his own mortality. I had a number of his terminal patients after that and he was just great with them.
When it was my 91 year old dad with pneumonia, we hospitalized him and did antibiotics and everything, but he was "Do Not Intubate". He was extremely ill but recovered and went home. However, he was very weak and not able to get around. He had dementia, and was so stubborn he wouldn't use a walker, so of course he fell and the home care aide couldn't get him up. It was at that point that we had him put back in the hospital so he could be evaluated for rehab in a SNF. He was placed, but soon refused to cooperate with rehab so we stopped it and let nature take its course and he died of CHF several weeks later. We had made him a DNR before he was place. Lessons were learned! My brother the MD said that in retrospect he didn't think we should have hospitalized him the first time. My other brother disagreed but said we probably should have sent him straight to the SNF. Lessons learned...we kept mom at home with a full-time caregiver until her death 3 years later. She was a DNR, and was on hospice for the final 6 months of her life, and when she got sick the last time (probably aspiration pneumonia) the doctor prescribed PO abx. She took a couple of doses mashed up in pudding but then refused any more PO, and died quietly in her own bed with her namesake granddaughter beside her and the music of her youth playing softly on the radio. My daughter said she was smiling.