Medical ethics: what do you do in these scenarios?

[The world will shine with light in our nightmare]

Based on a medical ethics conference my cousin attended in Baltimore (not to attend the seminar, but to advertise and represent her company).

Suppose you are a doctor and you have a patient who has a DNR. One of two scenarios plays out:

Scenario 1: The patient becomes unconscious, and his daughter tells you that in his final breath, he told her he wanted to be resuscitated. What do you do?

Scenario 2: The patient himself has personally told you to resuscitate him in his final breath and becomes unconscious. What do you do?

[dead0man]

1.no
2.yes

[The world will shine with light in our nightmare]

I should probably explain and justify my votes here.

Scenario 2 is pretty easy to me. If the patient expresses that they want to be resuscitated, then some document they signed 40 years ago shouldn't matter.

Scenario 1 is more complicated, but I would still resuscitate in this instance. The consequences of potentially making the wrong move in not resuscitating are permanent. Resuscitating the patient may or may not piss them off if by some miracle they regain consciousness and all or most mental faculties, but in this situation I'd rather err on the side of saving the patient, and letting them die naturally should that be the case.

That's not to say there aren't other potentially negative consequences, of course. And this is sort of where the euthanasia question comes into play here, but we're not opening that can of worms. But I think end-of-life care is a secondary question to whether or not you should save the patient's life.

[Independents for Nihilism]

Scenario 1 is more complicated, but I would still resuscitate in this instance. The consequences of potentially making the wrong move in not resuscitating are permanent. Resuscitating the patient may or may not piss them off if by some miracle they regain consciousness and all or most mental faculties, but in this situation I'd rather err on the side of saving the patient, and letting them die naturally should that be the case.

My understanding is that a DNR exists to give a patient the right to not be potentially stuck in a coma or otherwise unconscious state with reduced mental faculties? Obviously this is tough because you don't know what was genuinely the patient's desire, and of course death is permanent, but arguably somebody with a DNR believes that whatever outcome occurs from not "naturally" dying is worse than death, or else they wouldn't have a DNR. Though I do see what you mean that generally, letting somebody live who may not have wanted to, is not as bad as letting somebody die who wanted to live.

All this in mind, having to take stuff like this into consideration is why I wouldn't have made a good doctor (that, and my poor neuroanatomy grades).

[The world will shine with light in our nightmare]

Scenario 1 is more complicated, but I would still resuscitate in this instance. The consequences of potentially making the wrong move in not resuscitating are permanent. Resuscitating the patient may or may not piss them off if by some miracle they regain consciousness and all or most mental faculties, but in this situation I'd rather err on the side of saving the patient, and letting them die naturally should that be the case.

My understanding is that a DNR exists to give a patient the right to not be potentially stuck in a coma or otherwise unconscious state with reduced mental faculties? Obviously this is tough because you don't know what was genuinely the patient's desire, and of course death is permanent, but arguably somebody with a DNR believes that whatever outcome occurs from not "naturally" dying is worse than death, or else they wouldn't have a DNR. Though I do see what you mean that generally, letting somebody live who may not have wanted to, is not as bad as letting somebody die who wanted to live.

All this in mind, having to take stuff like this into consideration is why I wouldn't have made a good doctor (that, and my poor neuroanatomy grades).

There's another factor at play here, at least as it pertains to consistency. As of now, everyone seems to agree that it's okay to violate a DNR if the patient wishes to, verbally, rescind it at the time they're in hospice care. But you are still, in effect, violating the DNR, which logically implies that a DNR is not necessarily the final authority in all cases; the final authority rests with the patient's wishes at the current time.

Therefore, logically the DNR may be compromised in other ways as well. If the DNR is the final authority, the "correct" thing to do would be to not resuscitate - regardless of what the patient wants at the current time. While that makes sense from a strictly legalist standpoint, it doesn't from a moral standpoint.

Like you though, I also appreciate the fact that I'm not in charge of these decisions. PQG's input here would be interesting.

[Ferguson97]

Scenario 2 is pretty clear cut; the verbal wishes of the patient override the piece of paper.

Scenario 1, I would not resuscitate, because he had a DNR, and he did not personally communicate to us that he had changed his mind. The daughter could be telling the truth, but it's also likely that she is going against his wishes because she can't bear to lose him. It's very sad, but the wishes of the patient supersede the wishes of the family.

[Del Tachi]

1.no
2.yes

[It’s so Joever]

Which one would cause the least amount of potential legal headache for me?

I am thinking maybe no one both cases but I’m not at all versed in this field.

[Donerail]

There's another factor at play here, at least as it pertains to consistency. As of now, everyone seems to agree that it's okay to violate a DNR if the patient wishes to, verbally, rescind it at the time they're in hospice care. But you are still, in effect, violating the DNR, which logically implies that a DNR is not necessarily the final authority in all cases; the final authority rests with the patient's wishes at the current time.

I have no background in medical ethics, but I do have a background in interpreting things from a strictly legalistic standpoint, and I don't think there's any logical inconsistency here. You are not "violating" the DNR in this scenario because you can't violate a document that's been rescinded. If you sign a contract to sell something and then rescind the contract, you can't then sue for breach of contract based on the contract that's already been rescinded. The DNR is the final authority if it's still in effect, but the patient is free to revoke it at any time; this is the difference between a DNR and a suicide pact.

Therefore, logically the DNR may be compromised in other ways as well. If the DNR is the final authority, the "correct" thing to do would be to not resuscitate - regardless of what the patient wants at the current time. While that makes sense from a strictly legalist standpoint, it doesn't from a moral standpoint.

This only follows if you think the DNR is irrevocable. It is the final authority until it's rescinded, in which case it isn't. Some contracts are irrevocable, but for obvious reasons patients should be permitted to rescind DNRs at any time.

The strictly legalistic standpoint here is to always resuscitate in scenario 2, because the patient himself is who signed the DNR and the patient himself can revoke it. You wouldn't resuscitate in scenario 1, unless the daughter has power of attorney or is otherwise empowered to make decisions for her father. In the second one, you know you're respecting the wishes of the patient; in the first one, you don't.