Saturday, 6 September 2014

Code 99.

Two doctors at Sunnybrook Health Sciences Centre in Toronto are being charged with violating the law by imposing a "do not resuscitate order on an elderly man against the family's wishes.
   The man, who was eighty-eight years old had congestive heart failure, diabetes,  high blood pressure and chronic obstructive pulmonary disease, had also had severe arterial disease, serious enough to result in a bilateral lower limb amputation.
    Apparently, the patient's family had originally, presumably in consultation with his medical care-givers arrived at a 'do not resuscitate order'.  In other words if the patient died, there would be no attempt to bring him back to life.
     His daughter and family, presumably changed their minds before his double amputation and requested a full 'code', a request that was documented on the patient's chart.  The doctors later changed the order to a 'do not resuscitate' order.  This was done on the basis that bringing an 88 year old man, with this sort of medical history  back to life was not a humane act, but one that would increase pain and suffering, not relieve it.  Unfortunately, no one had discussed this with the the daughter.and this was wrong.
      The issue seems to boil down to who has the final say when the medical staff feel that bringing a patient back to life,(and that is what we are discussing, not treatment) is inhumane and likely to result in a second death, in a short time.  Of course loving families want their loved ones to live forever but they also want to spare them further suffering.  It is not an easy or simple situation but is one that can usually be resolved by physician and family collaboration.  Changing the order without thoroughly exploring and discussing the situation with the family can only lead to anger and frustration.
      Perhaps a well thought out and documented advance directive might avoid this sort of outcome in most cases.
       I love life, but if I'm dead, please don't bring me back.
         If you have any opinions at all on this issue, please make a comment.

1 comment:

  1. My neighbor and friend, and sometimes doctor, was director of the intensive care unit in a large Montreal hospital. In that capacity he was often called upon to make life-and-death decisions regarding his patients. On one occasion, when he decided not to resuscitate an elderly patient he was ultimately sued by the patient's family. The ensuing court case was very stressful for the doctor, who himself had a problem with obesity. He was sitting in the court room waiting to be called to testify. Eventually his turn came and he was called to approach the witness box. When he did not respond and appeared to have fallen asleep the bailiff approached him and shook him to wake him up. The doctor slumped in his chair. He had died while sitting in the courtroom awaiting his turn to testify!

    I recall that sad story to illustrate the incredible stress on a patient, the patient's family and the medical staff in difficult end-of-life cases. Doctors, in such cases, are themselves placed under sometimes unbearable stress in making very difficult life-and-death decisions. Your recommendation to prepare an advance directive is well received. Such a move could reduce the burden of anguished decision-making from both the patient's family and the treating physicians.