What would you do...

[Lone Star]

That is scary(verbal DNR), and something I would not want to deal with. I see HUGE potential problems with family disagreements. Even with a written DNR, there may be conflicts within a family, but at least you as a provider, that written DNR covers your arse.

One of the potential problems with a 'verbal DNR' is that the family is tired of seeing X(insert family member here) suffer, so they decide among themselves to to the 'humane thing' and let the suffering end. While noble in it's intention, without that valid DNR, we cannot guarantee thats what the patient wants.

I'm not prepared to follow in Jack Kevorkian's steps and commit 'EMS assisted suicide' (or would that be 'EMS murder'?).

[JPINFV]

One of the potential problems with a 'verbal DNR' is that the family is tired of seeing X(insert family member here) suffer, so they decide among themselves to to the 'humane thing' and let the suffering end. While noble in it's intention, without that valid DNR, we cannot guarantee thats what the patient wants.

I'm not prepared to follow in Jack Kevorkian's steps and commit 'EMS assisted suicide' (or would that be 'EMS murder'?).

Since the 2 dollar phrase for "DNR" "voluntary passive euthanasia," do you refuse to honor any DNR at all? Furthermore, do you refuse to honor any DNR, written or verbal (since verbal in my situation was a valid DNR) after the patient became incapacitated? Sure, the POA:HC or another immediate relative like a spouse signed the DNR (cosigned by the physician), but how can you be sure that's what the patient wanted? If a loved one is on home hospice and the family doesn't have the DNR form in the house, should they be charged with murder if they simply don't call 911 when their loved one takes a turn for the worse?

Edited September 7, 2010 by JPINFV

[HERBIE1]

One of the potential problems with a 'verbal DNR' is that the family is tired of seeing X(insert family member here) suffer, so they decide among themselves to to the 'humane thing' and let the suffering end. While noble in it's intention, without that valid DNR, we cannot guarantee thats what the patient wants.

I'm not prepared to follow in Jack Kevorkian's steps and commit 'EMS assisted suicide' (or would that be 'EMS murder'?).

I've seen it many times. There always seems to be at least one family member who does not accept the fact their loved one is terminal. They object to even the mention of a DNR, family fights develop over who has power of attorney, some who can't wait to carve up grandman's estate for their inheritance, some who somehow think their family member will suddenly wake up from end stage Alzheimers and be fully cognizant and functional, or the metasticized cancer that has ravaged someone's body will suddenly clear up and the person will be cured.

I too understand the intent of a verbal order, but I would much rather see that topic broached at the hospital, with tons of witnesses- and a team of lawyers- to back up that decision.

[Richard B the EMT]

One of the potential problems with a 'verbal DNR' is that the family is tired of seeing X(insert family member here) suffer, so they decide among themselves to to the 'humane thing' and let the suffering end. While noble in it's intention, without that valid DNR, we cannot guarantee thats what the patient wants.

I see a problem I don't believe has been addressed with a "Verbal DNR Order".

Scenario:

Grandfather is rich. I don't want to wait until he succumbs to the lung cancer, which may be a whole month from now, before I get all that money he's (presumably) willed me when he goes. I'll just tell those EMS folks there's a DNR order, so they won't help him with his difficulty breathing, and I'll get all that nice money sooner than later!

It could happen, and actually might have happened. Watch the next episode of "CSI", "Law and Order", or "The Defenders" to find out!

OK, I'm being a bit sarcastic, but you have to admit that it might have happened somewhere, sometime, even centuries ago, before anything even resembling an EMS system existed.

[Just Plain Ruff]

I see a problem I don't believe has been addressed with a "Verbal DNR Order".

Scenario:

It could happen, and actually might have happened. Watch the next episode of "CSI", "Law and Order", or "The Defenders" to find out!

OK, I'm being a bit sarcastic, but you have to admit that it might have happened somewhere, sometime, even centuries ago, before anything even resembling an EMS system existed.

The only pre-hospital DNR I'm allowed to honor by state statute is the out of Hospital DNR on a orange piece of paper.

Our service does honor the nursing home, home health, and hospital DNR's that the patient has.

If they can't produce the dnr and say "He's got a DNR at the hospital" or this is a beauty "His DNR is at his attorneys office" I'm not going to honor it. I'm going to work the code and let the hospital deal with the aftermath.

I've had times where I've gotten on scene and the patient tells me "I have a DNR but I don't want to die". I'm on the phone with medical control telling them what the patient just told me. 100% of the time, the physician said "if he codes, work him"

[JPINFV]

some who somehow think their family member will suddenly wake up from end stage Alzheimers and be fully cognizant and functional, or the metasticized cancer that has ravaged someone's body will suddenly clear up and the person will be cured.

So what do you say if family requests resuscitation while on scene? For consistency, shouldn't you disregard the family in this case as well?

[HERBIE1]

So what do you say if family requests resuscitation while on scene? For consistency, shouldn't you disregard the family in this case as well?

I have actually run into that a couple times. We work the patient, but I do ask tactfully why the change of heart. Obviously the outcome was inevitable, but as doc said, you will never get in trouble for trying to revive a patient- especially with a conflict like that. I would also contact medical control ASAP and put the ball in their court. I've even had hospice folks call us which is a real puzzler. Turns out they called because the family panicked at the last minute when the inevitable finally happened. I tore that nurse a new one for putting us in the trick bag like that- she should have known better and/or better prepared the family.

The only pre-hospital DNR I'm allowed to honor by state statute is the out of Hospital DNR on a orange piece of paper.

Our service does honor the nursing home, home health, and hospital DNR's that the patient has.

If they can't produce the dnr and say "He's got a DNR at the hospital" or this is a beauty "His DNR is at his attorneys office" I'm not going to honor it. I'm going to work the code and let the hospital deal with the aftermath.

I've had times where I've gotten on scene and the patient tells me "I have a DNR but I don't want to die". I'm on the phone with medical control telling them what the patient just told me. 100% of the time, the physician said "if he codes, work him"

So if a person is getting hospice care at home, with a valid DNR, you do not honor it? Really? I agree that unless I have that piece of paper, it may as well be nonexistent. I've also heard the - "My lawyer has the" DNR". They offered to call the lawyer for me. I declined.

The only exception is speaking on the phone with the patient's doctor, verifying the PT is a DNR. I have had that issue a couple times- the DNR was being updated, amended, etc or the patient arrested far sooner than expected and they simply did not have the copy of the order on hand. Once, the patient was discharged from the hospital- earlier that day I believe- and the patient arrested. The doctor was completely in shock on the phone- she assumed the patient had at least 6 months or so. She kept saying- "are you sure"?

As the doc said, unfortunately this isn't always a black and white issue, as much as we would like it to be. One of the many joys of the medical/legal profession, I guess.

[Just Plain Ruff]

If they are on hospice and have a valid DNR that falls into the list of the ones I listed above.

Basically if there is a DNR that is presented to us, we honor it. But in Missouri the only legally EMS recognized DNR is the Out of Hospital DNR which is on a bright orange piece of paper. If they don't have that I could feasibly work the code.

But in all reality and seriuosness, if I'm presented wiht a signed DNR on a form that has the doc's signature then we are going to honor it.

But if there is a question of validity, I'm on the phone with medical control and discussing it with them. Of course we are working the code at the time until I get clarification.

[Don1977]

So, in court which would be the "higher authority" The DNR or the state protocols??? The protocols tell you to use Adenosine, but the DNR tells you no CPR, etc., but you killed the patient only because the protocols told you to.

Kinda between a rock and a hard place with this one......

[Just Plain Ruff]

So, in court which would be the "higher authority" The DNR or the state protocols??? The protocols tell you to use Adenosine, but the DNR tells you no CPR, etc., but you killed the patient only because the protocols told you to.

Kinda between a rock and a hard place with this one......

I think you are right Don.

I'm not sure who the higher authority would be, but since I've never been put in that situation to have to go to court I can't answer it.

If the patient goes into arrest from the adenosine then I'm going to honor the DNR but I'm calling the doctor to cover my ass.

I have ideas of what would happen if we caused the arrest on a patient with a DNR but they don't need to be put out on this forum.