Quick Tip for Families in Intensive Care: Who Decides Patient and Family Rights on DNR (Do Not Resuscitate), DNI (Do Not Intubate), and Life Sustaining Treatment

Who decides patient and family rights on DNR, DNI, and life sustaining treatment?

My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence. Even if you’re not a doctor or a nurse in intensive care. Making sure your loved one always gets best care and treatment.

Now, in today’s topic is one that I deal with all the time when talking to families in ICU all over the world. And that is who decides on DNR, which stands for do not resuscitate, DNI, do not intubate, and other life sustaining treatments. And let me tell you straight away, hospitals and ICUs will often make you believe they decide, but the truth is, they don’t.

Patient rights come first.
If your loved one is awake and competent, they decide for themselves, full stop. That means they can accept or refuse any treatment, CPR, ventilation, dialysis, surgery, you name it. They can sign in an advance directive, they can request treatment, or they can refuse it, but it has to be their decision, not the hospitals or the ICUs.

Let’s look at when the patient cannot decide.
Now, what if your loved one can’t speak for themselves? Maybe they’re in a coma, maybe they’re sedated, maybe they’re just too sick to communicate. Well, that decision then falls to the person they appointed as a medical power of attorney or healthcare proxy.

If no one is appointed, then the law gives that right to the family, starting with the spouse, then adult children, parents, siblings, and so on.

And this is where ICUs often cut families out. I’ve seen it over and over and over again. They’ll say, we’ve decided your loved one is not for resuscitation. No, no, I can tell you that’s not how it works. It’s absolutely not their decision to make. ICUs are very good at pretending they can do whatever they want until you challenge it.

See what happens if you challenge them, you will see the dynamics change very quickly in your favor. And imagine you have someone on your side, like me, who understands intensive care inside out. It’s been consulting and advocating for families in intensive care for over a decade now.

And we have saved many lives with our consulting and advocacy, as is evidenced in our testimonial section at intensivecarehotline.com. And it’s also evidenced on our intensivecarehotline.com podcast section, where we’ve done client interviews.

So, what do you do when doctors say consent is not needed?

Now, you’ll hear hospitals say consent is not needed because treatment is “futile”. What does that even mean? Well, if CPR (Cardiopulmonary Resuscitation) or ventilation truly has zero chance of working, for example, in an irreversible cardiac arrest, then yes, doctors can write a DNR. But here’s the problem. I’ve seen “futile” used as an excuse and not as a reality, not because treatment won’t work, but because it’s expensive, time consuming, or because the ICU needs the bed.

So always ask what do you mean by futile. Show us your evidence. And bear in mind futility is often based on perception and perception alone. And the perception is not reality.

Then look, let’s look at withdrawing versus withholding treatment. Let’s clear up another myth. Withholding means not starting a treatment like choosing not to intubate. Withdrawing means stopping a treatment like taking someone off the ventilator. Legally, they’re treated the same, but ethically, it’s a huge decision and families must be involved every step of the way.

So, why families must push back. Here’s the reality. Hospitals and ICUs are under constant pressure to free up beds. And sometimes, sadly, that means pushing families into agreeing to DNRs, DNIs, or withdrawals of life support prematurely. Not because it’s, “in the best interest of the patient but because it’s in the best interest of the hospital”.

I can’t tell you how many times I’ve seen patients survive, recover, and leave ICU after being written off by ICU doctors, and it happened only because their family said, no, keep going. We want treatment.

So, if you’re being pressured right now, remember, it’s not the ICU’s decision. It’s not the doctor’s decision. It’s either your loved one’s decision or yours as the family and appointed surrogate.

Also, keep in mind, you must discriminate between whether your loved one is in a real or a perceived end of life situation.

What’s the difference? I’m glad you’ve asked.

A real end of life situation is a situation in ICU where nothing, and I mean absolutely nothing, no treatment, no surgery, no equipment, no fancy drugs, no nothing, will save your loved one’s life. That is a real end of life situation.

A perceived end of life situation is a situation where end of life might be an outcome, but survival might also be an outcome if best care and treatment is offered.

How do you know what best care and treatment is? Well, that’s when you reach out to us here at intensivecarehotline.com, so we can educate you on treatment options, on educating you on your rights and helping you to put those rights into place.

Also ask the ICU for their DNR, or life support, or end of life care policy. And you will see that everything that I’ve said right now is documented in the end-of-life care or DNR or DNI policy.

So don’t do anything without having all the evidence in writing. The minute you challenge them on their policies, you will see them turn around and you will see them becoming defensive, and you will also see that you will get what you are asking for. Final word.

Who decides on DNR, DNI, or life support? The patient, if they’re competent. If not, the medical power of attorney or family. Doctors only step in if there’s truly no chance of survival or no family available, and even then, it must be documented.

If you’re in this situation right now and you feel the ICU is railroading you into signing a DNR or withdrawing treatment, reach out to us at intensivecarehotline.com. We can give you the questions to ask, the strategies to push back on, and the confidence to make sure your loved one gets the best care and treatment they need and deserve.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.