Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is a special update, as this month a court in the UK confirmed that Clinicians can’t issue DNR(Do not resuscitate) or NFR(Not for resuscitation) orders without consulting Patient and/or their families first!
This unfortunate, but widespread practice in Intensive Care Units is happening all across the world, often without the knowledge or consent of critically ill Patients and their families!
Professor Thaddeus Pope, who is a medical futility lawyer has posted these news on his blog http://medicalfutility.blogspot.com last Thursday(19th November 2015).
This is another win for Patients and their Families in Intensive Care! Often clinicians in Intensive Care think and believe that they are the only ones who know “what’s best” and “what’s in the best interest” of a critically ill Patient and they don’t consult with critically ill Patients or with their families.
This is shocking and I have seen this unfortunate practice over and over again in more than 15 years Intensive Care nursing in three different countries, where I literally worked with thousands of critically ill Patients and their families.
I have also worked as a Nurse Unit Manager in Intensive Care for more than five years and I have seen it all…
Once again, just like in another verdict a few weeks back in Ontario, Canada the rights of families in Intensive Care when it comes to decision making in real or perceived end of life situations are heard and finally doctors in Intensive Care need to consult with families before issuing an NFR(not for resuscitation) or DNR(Do not resuscitate) order!
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT” OR “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR AN “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
In general, there is way too much power that lies with Intensive Care teams to issue NFR(not for resuscitation) or DNR(Do not resuscitate) orders without consulting with critically ill Patients and their families first!
There is way too much of the perception in Intensive Care that only Doctors know “what is best” or “what is in the best interest” of a critically ill Patient in Intensive Care, especially in real or perceived end of life situations!
Lets get into the meat of what Professor Pope blogged about on the 19th November 2015 on his blog
UK Courts Remind Clinicians – No Unilateral DNR without Consultation
In 2014, the UK Court of Appeals handed down its judgement in Tracey v. Cambridge University Hospitals NHS Foundation Trust, clarifying that clinicians must consult with the patient before writing a DNAR order.
A study earlier this year showed that most UK clinicians had never heard of the case. And practice regarding DNAR orders had not changed.
This month, a new case confirmed the holding in Tracey and extended it to require consultation with the family when the patient lacks capacity.
At 3:00 am on January 3, 2011, clinicians wrote a DNAR order for incapacitated Carl Winspear without consulting his mother or family. The physician “did not want to inflict on Carl as treatment that was distressing, painful, undignified, and futile because it had no chance of success.” When his mother learned about it, she had the DNAR order withdrawn at 12:30 pm the same day.
While Carl never coded during the 9 hours the DNAR order was in effect, the High Court held that the clinicians violated Carl’s rights under the European Convention on Human Rights. “Ms. Winspear as carer does not have a veto over the treatment plan but she is entitled to be consulted . . . .”
“I accept the claimant’s case that the core principle of prior consultation before a DNACPR decision is put into place on the case file applies in cases both of capacity and absence of capacity. The fact that there was no cardiac arrest before the notice was cancelled is not decisive, as its existence is itself an interference with private life; it is an important decision about medical treatment of a potentially life saving nature.”
“If . . . it is both practicable and appropriate to consult then in the absence of some other compelling reason against consultation, the decision to file the DNACPR notice on the patient’s medical records would be procedurally flawed.”
“The discharge of this procedural obligation is not a matter of challenging a clinical judgment as to the appropriate treatment for a patient. The formation of such a judgment is a necessary first step in the decision making process before a DNACPR notice is placed on file but not generally a sufficient one.”
PS: I have also interviewed Professor Pope on two separate occasions on my podcast. You can listen to the interviews here
- INTERVIEW WITH MEDICAL FUTILITY LAWYER PROFESSOR THADDEUS POPE ABOUT MEDICAL DISPUTES IN INTENSIVE CARE REGARDING END OF LIFE DECISONS
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- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!