Issues Raised by Media Coverage of a Nurse Declining to Do CPR

I disagree w/ J. Paradisi RN, who said that no one should die in a residential bed “or on the floor”……we don’t know where the ill woman was. Probably in her bed, I’d assume. WHY would she have moved her? Instituted WHAT “comfort care”??? If the woman was in the process of dying, perhaps even comatose, she needed LESS, not MORE intervention by strangers.

The facility should have had mandatory DNR’s in the files of patients who wished for them. Otherwise, they should have supported the nurse (if she was a nurse, not an aide) in doing CPR. BUT, if the patient had an understanding, even verbal, that she was a DNR, then that should have been lived up to.

I don’t understand WHY the “nurse” called 911…..that’s another unanswered question in this confusing case.

A major part of the lack of public understanding is that a lot of the general public choose not to have “the discussion” about end of life wishes feeling it is “too morbid”. Everyone knows you don’t get out the world alive but subscribe to the Scarlett O’hara school of thought-“I’ll think about that tomorrow”. The general public has little perception of the realities of what happens when we resuscitate someone but their body is devastated from the initial insult. Just once I would like to see a general public medical show that shows “survivors” of resuscitations where we really shouldn’t have given that “last dose of epinephrine”. I recall that a few years back, the Advanced Cardiac Life Support manual included a statement that sometimes the last beat of a patient’s heart should be the last beat. It has been removed from subsequent manuals.

This is an excellent post regarding the pit falls of trial by media, public perception of emergency care, CPR, and end of life issues.

As mentioned by the author, the facts of this story remain unknown. Most importantly, is knowing the patient’s POLST (Physician’s Orders for Life Saving Treatment) status. Secondly, if a POLST exists, outpatient facilities must have a mechanism to provide comfort measures for a patient with a signed DNR. It is inhumane and inappropriate to allow a human being to expire on a lobby floor or resident bed (we don’t know) without initiating comfort care. It may mean the patient requires medical transport to a location where this can be accomplished, without initiating the EMS (Emergency Medical Response).

Well put Doug!