The Ethical Implications of Unilateral Do-Not-Resuscitate Orders

[@hollish196]

It is extremely disturbing that this had been available for a week, and I am the only one who has responded. I am an old white woman.This is just frightening.

[@ptrcklalor]

The idea of a UDNR in and of itself is just wild to me. Especially if there is family present and advocating for the patient. My father was admitted to an ICU in November of 2020 for Covid. He is Hispanic, and at the time, he was 65 years old, and receiving immunotherapy for stage IV lung cancer. He also had a history of heart disease, stroke, and type II diabetes. Almost daily we were asked to sign a DNR. They even tried declaring him brain dead and we had to beg them to start dialysis because we knew he was just over sedated. At every turn they wrote him off and even made unexplainable treatment decisions seemingly trying to help him along to the other side. At a time when no visitors were allowed in the hospital, we were very fortunate to have a well educated family, and access to his mychart to review labs, imaging, and medications, etc. I hate to not give credit where credit is due to doctors with many years of education and experience but without a doubt we (the family) saved his life many times over by advocating, and challenging treatment decisions. I’m sure it also helped that my mother was an employee at the hospital and had reason to move about the hospital and Covid unit witnessing first hand the things that were going on inside. When the liability became to great for them, they sent him out to a step down facility/acute care hospital against our wishes and WHILE STILL ON THE VENT. The step down facility was a whole other monster. He just laid there and deteriorated. We would stand outside his patient room window in the snow for hours without anyone coming to do so much as reposition him to prevent bed sores. So of course he declined and was readmitted to the hospital. We were prepared the second time they tried to prematurely discharge him. We filed a dispute which required the hospital to get him down to acute care before legally allowed to discharge him, and this allowed him the time he needed to finally be weened off of the vent before being sent out. Ultimately, he spent 62 days on a ventilator. It was no easy road but he is still with us today and after some intense physical therapy he performs all ADL on his own. He showers himself, dresses himself, and cooks meals. He even still cuts the grass with a push mower. The only thing he has given up is driving. All of this to say that it feels very wrong that some doctors seemingly play god after spending just a short time with a “chart.” And given the crap they pulled on us, there is no doubt in my mind that those with any less socioeconomic standing were disproportionately affected by UDNR orders.

[@StevenBradleyMD]

I am so sorry you went through all of this :(

[@marshapowell8907]

Is it ethical for a Resident to place a DNR order on a patient after she botched a brain surgery on a patient who began hemorrhaging in the brain from an overdose of Heparin given by another employee at the same hospital? The patient was in a coma when the Resident arrived, and was unable to give consent to a DNR order,

[@StevenBradleyMD]

Unfortunately, I don't have enough information to comment on this sad scenario.

[@ptrcklalor]

Anyways …I landed here because I have a medical question that I think might best be answered by an anesthesiologist, but an anesthesiologist isn’t someone I can just make a doctors appointment with, and I couldn’t find any link on your webpage to send you a message. It would mean a lot to me to get a reply.