Override DNR Order Because of Medical Error?? How Disclosure Can Help...
Happy Friday afternoon! Welcome to the weekend!!
I just read a fascinating article written by our friend, John Banja, PhD, and his Emory University colleague Michele Sumler, MD. Title of the article is "Overriding advance directives: A 20-year legal and ethical overview" and it was recently published in the ASHRM Journal.
Long story short, the article discusses the possibility of physicians and nurses overriding DNR orders due to medical errors So, for example, a terminally ill patient with a DNR codes because of a drug overdose and the medical team believes they have a reasonable chance of reviving the patient -- but should they? Banja and Sumler review several cases in their article which discuss the potential legal pitfalls of acting either way (proceeding with CPR or honoring the DNR even though medical errors were not contemplated or discussed when the DNR was written).
I think the disclosure movement can help in this type of situation.
For years we have advocated for the need to talk about errors before they happen, as well as after they happen. Call it informed consent or whatever you want, the medical community needs to be upfront that mistakes can happen and get patients and families thinking how such situations will be handled before they happen. We have encouraged clinicians to tell new and even current/existing patients about the remote chance of medical errors and if they are ever unhappy, angry, or confused for whatever reason they should contact the physician or office and here is our contact information (including e-mail addresses and cell phone numbers). We even provided a document you might incorporate in your practice. I think the Banja and Sumler article provides an extension of this thinking. Consider the following mock DNR discussion offered in their article:
"Now, Mrs. Jones, while we can imagine your heart's stopping and your not wanting us to try to restart it by resuscitation, suppose your heart stopped because of something unrelated to your illness. For example, sometimes hospitalized patients have bad reactions to the medicines or the treatments they receive that can cause their hearts to stop. And while this is quite rare, there have been cases where a patient gets the wrong drug or too much medicine that can cause them to go into arrest. Now, if something like that happened, Mrs. Jones -- and I don't think it will -- but if it did, would you still refuse CPR or would you want us to perform it? Especially if we thought there was a good chance of bringing you around."
To me, this is an honest discussion about DNR that truly covers all the bases and leaves no one -- including physicians and family members --- wondering what to do. I strongly encourage you to read the Banja and Sumler article and draw your own conclusions.
Have a great weekend!
Doug Wojcieszak, Founder and President
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