Most of the time, when an individual goes into cardiac arrest, they would want the doctors and nurses to do all they could to keep them alive. This includes cardiopulmonary resuscitation, inserting breathing tubes, IV lines, and defibrillating the heart to begin pumping again. However, many elderly or chronically ill patients chose instead to go peacefully if their heart stops beating. It can be traumatic for patients and their families if doctors ignore the individual's end-of-life decisions.
In a case study, Dr. Maria J. Silveira, MD, MA, MPH, looks at the situation where a man was resuscitated and kept alive on life support against his wishes. While there is not a lot of information on how often unwanted resuscitations are performed, a patient's medical care decisions should be respected.
Patients who are alert and able to communicate may be able to talk to doctors and make decisions about their medical treatment. However, when a patient is unable to communicate, doctors may have to rely on a DNR, an advance healthcare directive, or a living will.
A DNR stands for “do not resuscitate,” and a DNI is a request not to intubate. Patients who chose a DNR/DNI do not want to have chest compressions, receive certain cardiac drugs, or have a breathing tube inserted if they go into respiratory arrest or cardiac arrest.
In the case study, a 65-year-old man suffered from end-stage renal disease, injection drug use, and multiple infections while living at a skilled nursing home. During a routine vitals check, he was found to have shortness of breath, tachypnea, and was confused. Paramedics took the man to the emergency department (ED) to treat the patient. Doctors intubated the man and put him on a ventilator. However, a resident asked why the man was intubated when his records indicated DNR/DNI.
An analysis of the case indicated a number of errors led to the unwanted intubation. The patient's POLST form (Physician Orders for Life-Sustaining Therapy) had not been entered into the computer system before the man was intubated. The form was not included with the paperwork that was sent from the nursing facility to the hospital. The nursing facility doctor talked to the ED of the nearest hospital; however, the man was instead taken to a different hospital who had not spoken with the physician.
Many families struggle with a loved one's decision not to be resuscitated compared to what they would choose to do for a sick family member. However, a patient who has thought about how they want their body to be treated should be respected. They may be more concerned with the quality of life than the quantity of life. They may have also witnessed the traumatic experience of watching another family member kept alive through invasive medical treatment, convinced that they do not want to go through the same thing.
If you or a loved one has been injured as the result of a medical mistake, the Gilman & Bedigian team is fully equipped to handle the complex process of filing a malpractice claim. Our staff, including a physician and attorneys with decades of malpractice litigation experience, will focus on getting you compensated, so you can focus on healing and moving forward.