saving a life if it means loosing your license

[s3xiboy]

Long story short.

I work at a standard nursing home. Some residents go there to finish out there lives while having 24 hours staff to take care of them.

If someone who's family has power of attorney and chooses the patient to be a DNR/CMO (do not resucitate/comfort measures only) but the patient tells you they don't want to die before seeing there family at christmas (christmas eve is the day).

Which in turn means they wont go to the hospital, they will die in the nursing home. (in this case, within hours)

(also the family is on there way to see them, they have to fly)

would it be wrong to go against there families wishes, against the policy of the nursing home, and against the law even if it meant to save them so they could be with them on christmas day, even if there in the hospital?

sorry this story is all written wierd, but I've been put in that situation, and I followed policy. They ended up dieing without seeing there family and this was last christmas and I feel awful. I mean it's not killing me everyday, but I have that sad, what if feeling. Like maybe I should have done more.

The brass ring is that the woman grabbed my hand and said, "please dont let me die before christmas... please".

I mean, if I had through her on oxegyn, or cpr and intubated, she probabily would have been alive to see her family...

The woman was definatly no competent enough to make her own decisions and she still wanted to remain a DNR/CMO, she just wanted to live untill christmas...

no one else agreed with me and told me my career would be over if I had proceeded when she become unconcious... but what if she got her last dying wish.

its like an ethical issue. what are your opionions guys. please dont think im nuts... put yourself in my shoes.

 

[KaraBulut]

There is no ethical dilemma here. What you did was the only acceptable choice.

 

[Boyz615]

I can understand ur situation. People want you to play "God" I am not trying to be mean about it but when it time for you to go it don't matter. The sad part about this is probably someone making money out of all this.

 

[bankside]

If a person is competent to understand the concept of death, and they are able to excercise the mental faculties to plan to avoid death, and they are able to request your help in avoiding death, then it was probably unethical for a judge to have endorsed a power of attorney against the person's consent. In which case you did your best, but there was a horrible ethical injustice in place before it even became an issue involving you.

However, a Power of Attourney is not always imposed; it can be granted by the person willingly, for their own convenience, and it can be taken away just as easily. The person in your care might have thought it was a wise idea to plan for trusted loved ones to be able to exercise full authority if she slipped into a semi-conscious state or something. But that does not grant someone in her family a veto over matters of life and death when she can say quite clearly that she wants to live. If her family felt entitled to veto the woman's own wishes, then again there was a horrible injustice, but it lays at their feet. I'm starting to wonder why she would even want to see people like that again. If you work somewhere that has a policy requiring you to respect a voluntary power of attourney when the person can still act in their own name, then the policy is completely unethical, and possibly illegal. I would go so far as to seek legal advice before following any policy like that again because your license could be equally at risk by following a policy with so many potential ethical problems.

From the very little I know about this situation, I think it was probably unethical to withdraw treatment, but it also seems to me that you did act ethically in trying to do the right thing even if it didn't work out. I think the policy, and maybe the power of attourney itself in this situation, needs another look.

 

[Lefty]

hey, stop beating yourself up. stop it right NOW!!!!!
the person while in a lucid (not necessarily competent, but LUCID) state made the decision for no extraordinary actions on anyones part to keep the husk functioning while in its last gasps/throes of death.

that person, in making that request to change her final instruction, placed a burden and onus that was socially, morally and completely unfair.

you did follow the last competent and responsible request. you acted in the correct manner socially, politically and most of all morally.

had you done otherwise, would she have been aware of the artificial extension of her existence and taken pleasure from the false extension of the husks functioning? how much more emotional anguish would the survivors have been placed under? to what avail is artificially extending the function of a piece of meat that is drugged out, burnt out, used up and already prepared for the "final exit". would that time have granted anyone peace or solace? NOT.

no my dear sir, you actually performed her a last act of HUMAN kindness and allowed her to pass the the next level with some dignity. a tough choice for the guy by the bed emotionally yes but the fact remains you did as per the SPECiFIC instructions of the person who should have control of their destiny. you had no other option. did you performed your obligation to the patient in a diligent, caring and respectful manner. i don't know how much cleare i can make this to you

with the utmost respect and regard,

lcm/michael

 

[Corny]

I am confused .. how is it possible for the family to request something like that when the patient is still "bright" enough to tell you the opposite?
What about the Hippocratic oath?

 

[Corny]

I am not questioning the OPs actions, obviously in the given context he did the right thing.
I am just a bit shocked/confused that a family can decide over life and death of someone who obviously still is able to do it himself ..

 

[Lefty]

corny my german friend. the patient could have been the one to initiate the original 'no extraordinary effort' request and in fact, the way our boston friend posted leads me to believe SHE made the decision, not the family...who knows anything for sure except she has flown the coop. take care friend

 

[Corny]

that does not sound like the patient made the decision.

If someone who's family has power of attorney and chooses the patient to be a DNR/CMO (do not resucitate/comfort measures only) but the patient tells you they don't want to die before seeing there family at christmas (christmas eve is the day).

 

[bankside]

corny my german friend. the patient could have been the one to initiate the original 'no extraordinary effort' request and in fact, the way our boston friend posted leads me to believe SHE made the decision, not the family...who knows anything for sure except she has flown the coop. take care friend

Except anyone who can decide to give Do Not Resuscitate orders for herself can also change them whenever she likes. It isn't like "Who Wants to be a Millionaire" where you have to give your "final answer."

 

[Lefty]

hey corny, i based my interpretation of the patients orig decision on the 3rd fm last sentence in the op's post. with the exception of terminal coma or non compus mentis (sic...my spelling is worse than my vocab) i understand that the patient has to instigate the dnr request and or agree to it. i believe it is a legal action and heavily controlled. either way, our guy did the right thing....YA?

 

[KaraBulut]

In the US, the patient cannot determine DNR or "slow code" status. It must be initiated via a physicians order. "Living Wills" only communicate the desires of the patient and do not automatically confer a do no rescuscitate order.

It is ethical practice for the patient to weigh in on the decision before the order is written, however it is not necessarily a requirement. It is only in the case of pregnancy or intraoperative arrest that a DNR order can be disregarded without legal jeopardy.

If the patient has given medical power of attorney to another person, that person can request that the physician write the DNR order. The POA supercedes the patient's wishes unless it specifically states that the POA is effective only if the patient is unable to make their own decisions.

If the patient has a valid DNR order, then that is legally binding until it is rescinded with a second written order. In this instance, the only thing that could be done is to notify the physician that the patient has verbally expressed a desire to be resuscitated. However, without the written order to void the DNR, there is no choice but to honor the DNR.

 

[kevin7620]

If the patient has given medical power of attorney to another person, that person can request that the physician write the DNR order. The POA supercedes the patient's wishes.

...ONLY when the patient cannot make decisions for themselves. I can give POA for health care to person X, but it is meaningless until I am unable to make my own decisions...

 

[KaraBulut]

...ONLY when the patient cannot make decisions for themselves. I can give POA for health care to person X, but it is meaningless until I am unable to make my own decisions...

I was in the process of editing my post to clarify that point when you posted this response.

The POA must state the conditions under which the Power has been granted. Otherwise, it can be deemed to be absolute. If you want the decision-making ability to transfer only in certain medical circumstances, incapacities or conditions then you must state that when granting the POA.

It is also important to make the distinction that OP has titled the thread "saving a life" when in fact it would be more accurate to say "prolonging a life".