Withholding Treatment Of Elderly Patients

[allegator]

Is it common for doctors treating an elderly patient (90+) to have a tacit understanding amongst themselves that they won't do anything major (ie intubation or reintubation) even if the family requests that "everything be done" and the patient is full-code?

Have you ever witnessed doctors withholding such treatment when needed and then engaging in creative writing in the progress notes?

Curious to know how frequently, if ever, this kind of thing happens. I have a personal situation that I'm very troubled about.

Thanks

[VivaLasViejas, ASN, RN]

Distraught.........I wish I could tell you that the doctors who overmedicated my mother were held accountable, but they weren't because as laypeople, my sister and I had no idea that anything was wrong with her medication regimen. It was only years later, when I was in nursing school and going through a pharmacology class, that I learned how dangerous the combination of all those stimulants really was. Now, 15 years after the fact and a thousand miles away, there's no way to go back and sue anybody.......heck, some of those doctors probably have retired, moved on to other practices, or died for all I know.

I wish you the best in your efforts to get at the truth and hopefully make someone take responsibility for it. In time, you WILL heal whether or not you achieve "closure", but it can be a long process. Sometimes all we can do in the end is to recognize that we've done all we can, realize that there is a broken place in our hearts that can never quite be repaired, and make peace with it.

Peace be with you.

[kids]

I understand needing answers as part of the grieving and healing process; I lost my mom, mother-in-law and brother in a 3.5 month period this spring. I have put a lot of thought into this because there are some parallels to my mom's death earlier this year. Her official cause of death was lung cancer but in reality it was renal failure due to chemo damage. At the time I didn't ask the right questions and the oncologists didn't volunteer the information. For a long time I was angry. I wasn't given the option to do what I now know in my heart would have been the wrong decision, If I had know I would have insisted she be dialyzed. The instinct as a child (or parent of a child) is to want everything possible done to save their life. When it feels like everything wasn't done here is a huge amount of guilt that you have failed them and anger that you didn't have any choice.

I want to apologize in advance for coming off sounding harsh. Please understand it really is by no means my intent to be cruel.

I agree, more might have been done for a younger person with younger organs. 2.5 weeks of hospitalization with at least 1 intubation is fairly aggressive treatment even for a person in their 40s.

To summarize what I know Distraught's loved one: He was a 91 yo with dementia who had a 2.5 week hospitalization for CAP, small stroke. He was previously ambulatory with a good appetite. He developed respiratory failure and passed away. His family's request that he be re-intubated was refused.

The purely clinical part of my brain asks these questions (and they are easy to ask when I am not emotionally involved):

If his life had been saved what would the quality be?

If he had been re-intubated would he have been able to extubate?

If not would he be trached?

After the lengthy hospitalization would he be wheel chair bound?

Would he ever been ambulatory again?

Would he have the strength and cognitive ability to benefit from therapy?

If not, what would the likelihood of his falling and fracturing something?

If he did break a hip would he be a surgical candidate to repair it?

If not would he be bed bound?

Would he be able to cooperate with turning and repositioning to keep his skin intact?

If he was continent before his illness would he still be?

Would he still have the interest and ability to eat?

If not would he still have the cognitive ability to benefit from speech and occupational therapy?

If not would he be able to cooperate with NG feedings?

Would he tolerate the feedings without aspiration?

If he needed a GT placed would he be a surgical candidate?

If his kidneys failed from meds would he recovered from the acute failure?

Would he need dialysis for the rest of his life?

My suggestion (and what I did myself with my mom) is to write a letter to the hospital's medical director and giving the events as you recall them and outlining your questions. Be as unemotionally as you can and making no accusations (it sometimes helps to have someone who is not as emotionally involved compose it for you). Ask for an ethics or medical board review of the chart and ask for a copy of their decision. Do not mention possible legal action. At the first hint of a law suit the hospital will cease communication except through their attorneys and the only way you will get any answers is by spending a great deal of money on your own attorney. If that happens you will probably never get an actual explanation of why actions were or were not taken.

[allegator]

To summarize what I know Distraught's loved one: He was a 91 yo with dementia who had a 2.5 week hospitalization for CAP, small stroke. He was previously ambulatory with a good appetite. He developed respiratory failure and passed away. His family's request that he be re-intubated was refused.

Kids-r-fun, couple minor clarifications. He had no stroke, only CAP. He was getting less than half the recommended dose of quinalone although his renal function was normal. The records indicate they told me reintubation was necessary and I refused.

I will take your advice and do as you suggest and as you did.

Thanks