“Ethical query? ”
This is more of an ethical hypothetical. I work on the psych/soc team for a hospice, and this issue came up, but we couldn't get a consensus.
"E" has major depressive disorder on top of a new hospice diagnosis of a brain tumor. During the signing of hospice consents, she obtains a signed and verifiable DNR. A few days later, outside of the ER, she ingests every pill she had had at home, makes sure the DNR is visible and also has a handwritten note that she wishes to be an organ donor with whatever viable organs are left after she dies. Would the ER staff resuscitate her due to it being a suicide attempt, or would they have to adhere to the DNR?
"E" has major depressive disorder on top of a new hospice diagnosis of a brain tumor. During the signing of hospice consents, she obtains a signed and verifiable DNR. A few days later, outside of the ER, she ingests every pill she had had at home, makes sure the DNR is visible and also has a handwritten note that she wishes to be an organ donor with whatever viable organs are left after she dies. Would the ER staff resuscitate her due to it being a suicide attempt, or would they have to adhere to the DNR?
Female | 36 years old
2 Answers
This is an interesting predicament. I would consult with the hospital attorney for their opinion. Looks as though the prognosis is dismal. Should she be successfully resuscitated, what is the future for her? Does a patient have the right to choose to end their life when there is no hope for a cure? Will they be a financial burden to their family? Is/will she be suffering pain?
Tough situation. Personally, I would lean to honoring her wishes and not resuscitating her. However, many overdose patients do not require resuscitation, but merely supportive care until the drug wears off. I would be inclined to give the supportive care and not resuscitate her should she suddenly code.
Tough situation. Personally, I would lean to honoring her wishes and not resuscitating her. However, many overdose patients do not require resuscitation, but merely supportive care until the drug wears off. I would be inclined to give the supportive care and not resuscitate her should she suddenly code.
THIS IS A GOOD QUESTION. IN MY OPINION, THE FIRST QUESTION I WOULD WANT ANSWERED IF I WAS THE ATTENDING PHYSICIAN IN THE ED AND THIS PT WAS BROUGHT IN, IS 'SHOW ME THE DNR"! IS IT A TRUE AND LEGAL DNR. UNTIL I HAD VERIFICATION OF THAT. I WOULD TREAT THE PATIENT JUST LIKE ANY OTHER. ONCE I
HAD WHAT I FELT TO BE A TRUE AND LEGAL DNR, I WOULD STOP, OR IF IT HADN'T BEN STARTED, I WOULD FOLLOW THE DNR. ESPECIALLY IF I HAD FAMILY, ETC., TO
VERIFY. THE ETHICAL AND MORAL ISSUE HERE IS CLEAR. YOU FOLLOW THE PATIENT'S WISHES, BUT FIRST YOU MUST VERIFY THEM. THIS IS A COMMON DILEMMA IN THE ED.
HAD WHAT I FELT TO BE A TRUE AND LEGAL DNR, I WOULD STOP, OR IF IT HADN'T BEN STARTED, I WOULD FOLLOW THE DNR. ESPECIALLY IF I HAD FAMILY, ETC., TO
VERIFY. THE ETHICAL AND MORAL ISSUE HERE IS CLEAR. YOU FOLLOW THE PATIENT'S WISHES, BUT FIRST YOU MUST VERIFY THEM. THIS IS A COMMON DILEMMA IN THE ED.
