I am a student nurse...question about ethics and legal issues?

Question

What if the patient you are caring for verbally expresses to you (the nurse) and to the physician that she wants to be a "No Code" if and when her heart stops. You notice on the patient's later on that the doctor never ordered the no code. Your patient goes into cardiac arrest....do you give cpr or follow the patient's wishes. The patient has no living will.

Answer 1

Good question and quite a dilemma indeed.  The doctor, as I am sure you know, must order the DNR.  Despite what the patient says, you have to go with the order.  Ideally, you could call this oversight to the MD's attention to have the DNR ordered before you are faced with a code situation.

Answer 2

I ain't a legal expert so i am answering only the ethics part.The first question u have to ask is-Am i really in a position to make a decision? the 2nd question to ask is- Am i here for myself or the one lying there on the bed?If both, then what's the relative importance of each?

The important thing to understand is this-ultimately u have to feel good about what ever u do.What follows this line of thought is this- Will u feel more comfortable following the patient's directions or will doing otherwise make u feel better?

Of course, the question of keeping ur job is important in case it comes to that. but if u cant make such decisions in ur job r u really made up for this job?

No one can answer these for u. simply because u r ur own best friend(an ancient oriental saying)!My best wishes!

Answer 3

This seems really implausible.

If a patient was in a condition that serious or having surgery – basically any thing that could potentially incapacitate them – they’re usually required to express such a wish in writing as part of hospital procedure. My experience is that if a patient says they want to be DNR, the hospital’s on-duty social worker is brought in to take care of the admin stuff.

I’ve been through this twice in the last nine months, first with my grandmother who was dying of cancer. More recently with my father who had a host of potentially fatal issues. Both times the on-site social workers came in early on and took care of the basic living wills.  It’s something even small hospitals do as a matter of practice to cover their tails in this exact scenario.

Let’s just say what you mentioned could actually happen. You DO NOT honor a verbal wish in this case. If it’s not written in a document signed by the patient, it’s not a valid request. If you didn’t resuscitate without any physical proof the patient wanted that and they die, their family has every right to sue every medical professional involved as well as the hospital. For all they know, you were just negligent.

Answer 4

Ethically, you would want to follow the patient's wishes - but you'd also want to be sure of those wishes. Her statement could have been a momentary exploration of the idea. Without a living will, you cannot know whether the patient changed her mind later on or not.

Granted, the doctor's failure to record the request in the patient's chart makes it look like the patient may not have had the chance to sign, but until there is a signature, you must follow the ethical course (and hospital policy) or preserving life.

Legally, you could not do a No Code without something in writing.