Elderly woman dies as nurse refused CPR.

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NeuroLAX

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Unfortunately, the instant she touches that patient, she's liable for the expected outcome of death, which would be the likely result of an out-of-hospital arrest in an elderly patient, regardless of whether or not she started CPR. You can thank the litiginous nature of our society for her very clear instructions to not start CPR or grab a random person to perform CPR. Fortunately, if this happens on the street or outside a facility, good samaritan laws tend to protect people.
 
Depending on the state, a healthcare professional has the right to determine if CPR would be futile. I can think of a few patients that were full codes in which no compressions were performed. The media makes it sound like she killed this old lady. Sadly CPR rarely works.
 
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Unfortunately, the instant she touches that patient, she's liable for the expected outcome of death, which would be the likely result of an out-of-hospital arrest in an elderly patient, regardless of whether or not she started CPR. You can thank the litiginous nature of our society for her very clear instructions to not start CPR or grab a random person to perform CPR. Fortunately, if this happens on the street or outside a facility, good samaritan laws tend to protect people.

Yes, it's very disheartening. :thumbdown:

Did you happen to hear the part of the 911 call when the dispatcher told the nurse EMS assumes liability for giving instructions over the phone? The nurse still refused, even for another resident to perform CPR. Does this mean that in this case the facility's protocol supersedes EMS?

Thank you for your response.
 
Depending on the state, a healthcare professional has the right to determine if CPR would be futile. I can think of a few patients that were full codes in which no compressions were performed. The media makes it sound like she killed this old lady. Sadly CPR rarely works.

Hmm, I didn't know that. I assumed it was protocol for healthcare professionals to perform CPR unless there is an advance directive. How does one determine if CPR would be futile?
 
I'm watching the news now and apparently, despite the woman on the phone being a nurse, she wasn't hired as one. The news also reported that the facility isn't licensed to provide medical care. I guess that changes things a bit?
 
It feels like the media is jumping the gun on this story. This was the policy of the facility, which residents/powers of attorney were informed of before agreeing to live here. The daughter of the deceased woman, a nurse, stated she has no complaints. If you really have a problem with this, I would focus your anger more on the facility than the nurse who was following the instructions of her employer (and if she wasn't employed in her capacity as a nurse that's also something to consider).
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?

And forget the statistics on CPR success, it IS successful for a tangible, albeit small, number of people ESPECIALLY if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.
 
i seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do anything?

And forget the statistics on cpr success, it is successful for a tangible, albeit small, number of people especially if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.

+1
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?

And forget the statistics on CPR success, it IS successful for a tangible, albeit small, number of people ESPECIALLY if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.

-1

End of life care is always tough. There is probably a lot more to this story than we will ever know. What if the lady had asked the nurse for no heroic measures?
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?

And forget the statistics on CPR success, it IS successful for a tangible, albeit small, number of people ESPECIALLY if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.

Disclaimer: I don't know the details of the case but just offering another perspective. I disagree that not wanting to do CPR on an 87 year old lady doesn't mean you're devoid of morality. Modern medicine allows many to survive long past their time and doing CPR on most 87 year olds is just prolonging the inevitable. CPR isn't a benign thing and it's a hard recovery for young folks. All of the older patients I've seen come through after/during CPR that we get back survive on the machines for a few hours or days before they die. If I was getting on in years I wouldn't want them to do CPR on me and I cringe every time I hear the ribs crack on an older person. To me, it's prolonging the suffering.
 
How is it sad and irritating? People die. There's no point in prolonging the inevitable. She's not going to thank you for letting her live out a few extra days in agonizing pain with broken ribs.
 
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Giving CPR to an 84 year old who is unable to care for herself (as evidenced by the fact that she lived in a nursing home) having a heart attack hardly seems like a good idea.

I had an elderly relative who passed away recently after two strokes and two MI's. They treated him aggressively, even giving him a stent about three weeks before he died. Just the day before he died they were trying to have him stand up and walk on his gangrenous, infected foot. What the heck.

The last time I saw him he straight up asked me to kill him.

I currently work with CHF patients who time and time again tell me that they wish everyone (family and healthcare providers) would've allowed them to die after their most recent incident.

It's not like we're talking about people who have long, productive lives ahead of them here, nor are we talking about killing a person. This is about allowing a person to die when their time is up rather than forcing him or her to suffer so that we can all feel good about ourselves for having kept the person breathing for as many seconds as possible.
 
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Have any of you been to a nursing home?

Almost all of the residents are DNRs

I, for one, am not outraged at this story, this nurse, or this facility
 
I would agree with many of you in saying that prolonging of suffering is unwarranted. Ive also been thru the nursing home ordeal with family members and I can say if I get to that point just let me go... BUT this wasnt a nursing home. It was an independent living facility meaning that this lady wasnt bed ridden or completely decrepit. If it were a nursing home and she didnt have a dnr, CPR would have been started with no issue according to protocol.
 
Have any of you who are saying we should be outraged about this ever done CPR on an octogenarian? It is one of the worst feelings in the world to break an old persons ribs, have them tubed, lined, sent to the unit, only to die days later after a pneumonia. You feel like you made this persons last days on earth an agonizing experience.
 
...BUT this wasnt a nursing home. It was an independent living facility meaning that this lady wasnt bed ridden or completely decrepit...

ah yeah I didn't catch that from the article. But still 84 years old... come on. Will you really be doing the person more good than harm?
 
Have any of you who are saying we should be outraged about this ever done CPR on an octogenarian? It is one of the worst feelings in the world to break an old persons ribs, have them tubed, lined, sent to the unit, only to die days later after a pneumonia. You feel like you made this persons last days on earth an agonizing experience.

:thumbup::thumbup:

I have done CPR multiple times.

But have never seen a 80 yo brought back. Generally when you are 80yo and your heart stops working it isn't a reversible cause.



This article title is misleading. The women died of natural cause NOT because the nurse didn't perform CPR.
 
Have any of you who are saying we should be outraged about this ever done CPR on an octogenarian? It is one of the worst feelings in the world to break an old persons ribs, have them tubed, lined, sent to the unit, only to die days later after a pneumonia. You feel like you made this persons last days on earth an agonizing experience.

Many times unfortunately and I agree with you. Im not saying its what I would want for a family member, but I am saying that if you are out somewhere and someone collapses and is pulseless and apneic I think its within the realm of possibility to attempt to do something and not walk over the person or refuse to aid them in any way.
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?
Have done it before, will do it again.
Sometimes it's the right thing to do.
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?

And forget the statistics on CPR success, it IS successful for a tangible, albeit small, number of people ESPECIALLY if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.


If I had the choice of do the futile CPR and get sued or do nothing, I'm doing nothing. 84 y/o usually have a real good reason to code and even if by some miracle you get them back its likely not long before they code again.
 
Many times unfortunately and I agree with you. Im not saying its what I would want for a family member, but I am saying that if you are out somewhere and someone collapses and is pulseless and apneic I think its within the realm of possibility to attempt to do something and not walk over the person or refuse to aid them in any way.

+1

Unless it was known that she had a DNR order, it just seems like the natural course of action would be to assist an incapacitated human being. Something along the lines of implied consent. We don't even know if she had a DNR. Either way it didn't matter because of this policy, which I don't agree with. I'd like to hear a legal expert's opinion on whether the nurse could have given CPR without legal repercussion. If not as a nurse (which she wasn't hired for), then as a concerned good samaritan.

Several here have based their opinions and beliefs on how they would like to be treated when they get to her age. I respect your opinions and beliefs 100%. But we don't know what her wishes were, if she had an advance directive, or exactly why she died. So there is a degree of assumption in saying "it was inevitable, look how old she is, she died of natural causes." I suppose we will have to wait for the autopsy report to make any further comment, but I don't think that particular logic holds any water in this situation. It's about the policy at the facility.
 
I don't understand why people think it's such a good idea to keep old people alive. What's the point? There's only so much time and money to go around. If you need a bunch of expensive machines or procedures to stay alive, who is going to pay for it? We should be investing in education and job opportunities for the young, not social security and medicare.
 
+1

Unless it was known that she had a DNR order, it just seems like the natural course of action would be to assist an incapacitated human being. Something along the lines of implied consent. We don't even know if she had a DNR. Either way it didn't matter because of this policy, which I don't agree with. I'd like to hear a legal expert's opinion on whether the nurse could have given CPR without legal repercussion. If not as a nurse (which she wasn't hired for), then as a concerned good samaritan.

Several here have based their opinions and beliefs on how they would like to be treated when they get to her age. I respect your opinions and beliefs 100%. But we don't know what her wishes were, if she had an advance directive, or exactly why she died. So there is a degree of assumption in saying "it was inevitable, look how old she is, she died of natural causes." I suppose we will have to wait for the autopsy report to make any further comment, but I don't think that particular logic holds any water in this situation. It's about the policy at the facility.

You guys just aren't understanding the situation at all here. Walking past someone down on the street is a totally different situation than this. You would be covered by Good Samaritan laws in most states in that situation.

This "nurse" (or whatever) was an employee of the facility where this lady lived who is acting in her capacity as an employee of the facility where every resident has signed documents stating that they understand the response of the employees will be to call 911 if something happens to them. She may very well not be covered by Good Samaritan laws. Why you might ask? Well the wording goes a bit like this:

"No person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission."

Well now, it doesn't take much of a leap to say that any employee at a facility providing care for seniors who renders emergency care for those seniors could be held liable for the outcome of that care. I can't fault the employee in this situation for acting the way she did. Sure the EMS dispatcher said that EMS would take liability for the situation but who knows if that's even her call to make or if that's a call that could even BE made? Yeah, that'll hold up well in court against a signed document clearly stating the independent living facility's protocol.
 
You guys just aren't understanding the situation at all here. Walking past someone down on the street is a totally different situation than this. You would be covered by Good Samaritan laws in most states in that situation.

This "nurse" (or whatever) was an employee of the facility where this lady lived who is acting in her capacity as an employee of the facility where every resident has signed documents stating that they understand the response of the employees will be to call 911 if something happens to them. She may very well not be covered by Good Samaritan laws. Why you might ask? Well the wording goes a bit like this:

"No person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission."

Well now, it doesn't take much of a leap to say that any employee at a facility providing care for seniors who renders emergency care for those seniors could be held liable for the outcome of that care. I can't fault the employee in this situation for acting the way she did. Sure the EMS dispatcher said that EMS would take liability for the situation but who knows if that's even her call to make or if that's a call that could even BE made? Yeah, that'll hold up well in court against a signed document clearly stating the independent living facility's protocol.

Additionally for the nurse to actually get sued it would have to been shown that by not performing CPR the pt received a different outcome (aka harm). I don't know the data off the top of my head, but I want to say doing CPR in the field on a 80+yo has less than a 5% survival rate. Depending on the cause of death determined at autopsy that could easily be approaching a 0% survival rate.
 
I'm not sure there is any liability risk here, but I do see a professional standards issue in refusing to provide care to someone who is at least in extremis based on "company policy". I see that it would be professionally reasonable to refuse based on a DNR, patient is in rigor, someone saw the patient drop 30 minutes ago and wasn't breathing at that time, but if this nurse wasn't planning on CPR and no one else was around to do it, what is the point of waiting around for EMS? Yes, CPR is a low-yield thing, but if you saw a younger person drop in that facility (visitor, let's say), would you really be so comfortable withholding compressions?
 
I seriously can't believe that people aren't responding on here with outrage to this story... "litigious" nature of society or not; could you honestly live with yourself if you literally stood over some one who was unconscious and didn't do ANYTHING?

And forget the statistics on CPR success, it IS successful for a tangible, albeit small, number of people ESPECIALLY if started immediately with uninterrupted compressions.

Society is becoming void of morals and conscience. I would hope that our healthcare professionals would try to maintain these traits.

While I get where you are coming from and I do feel outraged, at the same time, I can understand where the nurse was coming from insofar as if she would lose her job if she helped, that makes it tough. I actually quit a job over an incident where my Tech position was eliminated due to funding issues at the hospital and I was temporarily working in an ED in a clerical position where I was not allowed to touch patients (despite being a licensed, experienced EMT) and I had to stand by as a coworker was injured when he tried to assist a large patient who was falling off a bed. Had I assisted, my coworker probably would not have been disabled but I had been written up days earlier for assisting nursing staff by letting them know of a couple of critical incidents I'd observed instead of sticking to my job description and pretending I didn't know better. They basically said to do NOTHING beyond what I was hired to do. My boss applauded me for stepping back and not violating policy to help a coworker. I felt terrible. I transferred out of the ED as soon as I could find a clinical job on another unit -- a couple of weeks later. When your job description and training conflict, that sucks. The nurse refusing to allow anyone else to assist, however, is super sketch and honestly the whole thing just sucks. I can't imagine why she would have been so adamant in not even allowing someone else to help.
 
It's unbelievable the crap that goes for news these days. Anybody who has ever spent any time working in a health care facility (all doctors, nurses, social workers, etc) knows this is a non issue. The patient was DNR. No CPR. Nothing to see here.

http://www.dailymail.co.uk/news/art...ing-dying-resident-CPR-DNR.html#ixzz2McPQwMD7

Death panels anyone?

That's annoying... this website has a lot of the 911 call transcript, and says she did not have a DNR: http://www.kget.com/news/local/stor...atcher-s-fight-to/g2pqsOnJJUGDHFDtxoK04Q.cspx

It's supposed to be an article from an interview with the executive director.
 
Granted dailymail is probably not the most reliable news source. The story is obviously meant to elicit disgust and appall...not report the news.
 
I get both sides of this issue, what I don't get is why everyone is referring to 84 like it is this crazy old age. It's old, but not so old that a strong individual wouldn't have more years. My grandpa went into Afib at 83 after a small stroke. His doc told us he was strong and felt he had many healthy years ahead of him (he was still fit/active) He was resuscitated, recovered, went through OT and is 94 and living on his own fully coherent. He is not someone the system is keeping alive on tubes , he only goes to the doc once a year for a physical. He has a full happy life with 18 grandkids and 8 great grand kids.
Conversely my grandma had a stroke a month ago at 84,and she was weak, sick, and tired. I convinced my family to sign the DNR because it was the civil thing to do. She died in her sleep a few days later.

The only point I would make is you have to know the patient, know their history, know their vitality, etc before you can really judge anything.
And old person with vitality, a will to live (different from a fear of death), and a happy lifestyle may be worth a cracked rib and painful PT/recovery (my grandpa says it was). Someone who's tired and frail, sick, and exhausted -it may just be time to let them go in peace and with some dignity.

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The pain of cracked ribs is more than just pain. It likely means ventilatory support a stay in the ICU and development of sepsis from pneumonia, UTI, etc. It's great to hear about your grandpa and it is true you never know what could happen but the "news" reports the story as if CPR is a benign process with an excellent t success rate. End of life care is a touchy subject and stories like this send the wrong message to the public IMO.
 
The pain of cracked ribs is more than just pain. It likely means ventilatory support a stay in the ICU and development of sepsis from pneumonia, UTI, etc. It's great to hear about your grandpa and it is true you never know what could happen but the "news" reports the story as if CPR is a benign process with an excellent t success rate. End of life care is a touchy subject and stories like this send the wrong message to the public IMO.

You're suggesting this woman was receiving end of life care at an independent living community?
 
How about if the news article read that "Nurse performed CPR on patient who had told everyone not to perform it in the event she collapses. Pt had ROSC, spent 2 weeks in the ICU on a ventilator, on pressors, developed pneumonia and then died. Total cost of visit >$100,000. Daughter suing RN and nursing home for violating the patient's express wishes. The daugther said "My mom went through horrible pain and suffering in her last 2 weeks, we thought we could trust the facility to care for her and her wishes, but obviously we were wrong. They assured us that no one would do such a thing."
 
You're suggesting this woman was receiving end of life care at an independent living community?

I think he's suggesting that DNR/DNI status is an end-of-life issue. Not that this was a hospice patient.
 
While none of the news stories make it clear whether or not the patient was DNR, all the ones I have read make it quite clear that the lady's daughter is very happy that CPR was not performed.

Also, the difference in the discussion of this article here and in the resident forums is very interesting.
 
You're suggesting this woman was receiving end of life care at an independent living community?

No. Just suggesting that had she been "saved" intubation and ICU were up next. Then likely complications and a greatly prolonged life with a tiny chance of success. For the record, if she was full code and I was there (not bound by some policy) I would have started compressions because it is what her status indicated she wanted. Whether or not I think that is for the best is another matter.
Also, to my earlier comment about deciding if CPR is futile, I had no clue until spending a month in the ICU. I thought an "effort" had to be made.
 
...not wanting to do CPR on an 87 year old lady doesn't mean you're devoid of morality...to me, it's prolonging the suffering.

It is not immoral to want to spare another person suffering - nobody wants to cause pain - but I believe that it IS immoral to stand by and choose death for another human being based on YOUR value judgements. In the absence of an advance directive (seems unclear in this case if there was one) who are you or I to say "what this person has in store for them should they survive is very unpleasant. I can't imgine them wanting that, so I will make no effort to help them"? It may not be what we would choose for ourselves, but we have no right to make that choice for another person.

If it turns out that there was a DNR, then fine. Case closed. But if there was not, then what the "nursing" staff at this facility did was choose certain death for another human being rather than a slim chance at life based on what? Scared to violate policy? Fine. Do as the 911 operator asked and hand the phone to a passerby or another resident.

In cases like this, if there is no DNR, I believe that morally we must err on the side of even a chance at life, regardless of what we might choose for ourselves or our loved ones.

IMHO.
 
No. Just suggesting that had she been "saved" intubation and ICU were up next. Then likely complications and a greatly prolonged life with a tiny chance of success. For the record, if she was full code and I was there (not bound by some policy) I would have started compressions because it is what her status indicated she wanted. Whether or not I think that is for the best is another matter.
Also, to my earlier comment about deciding if CPR is futile, I had no clue until spending a month in the ICU. I thought an "effort" had to be made.

I wasn't aware that the Emergency resident forum had an identical thread. Sorry for double posting :oops:. But I see several parallels. One thing that was mentioned is that we don't know what caused her to go down in the dining hall of an independent living facility. I really appreciate the medical students and physicians here who have been on codes, it adds excellent perspective to the situation.

But since at the moment CPR is what comes to mind in the event of an acute arrest out of the hospital, why can't a facility that isn't licensed to provide medical care allow their staff to attempt CPR, regardless of their training? EMS can provide these instructions, as indicated by the recorded 911 call. Wouldn't this just take a simple swipe of the pen to see that the facility assumes no responsibility for outcomes of CPR? If she were to have gone down in a grocery store, would the employees be allowed to perform CPR while the EMS is en route? It irritates me that people can't react to these situations without the fear of either being fired or sued. I understand the litigious nature of our society, but acting as a good samaritan should cover instances such as these where we don't know what happened (assuming she did not have a DNR).

I'm not saying the nurse did anything criminal. In fact I would be surprised if this police investigation leads to her being charged. I am aware that residents of the independent living facility sign a form that says no medical attention is directly on-site and that no CPR shall be attempted by staff. It's due to liability issues. If she was DNR, doesn't matter what the policy is. But if she was not DNR, this policy prevented a trained nurse from performing CPR while waiting for EMS to arrive. If she died en route to the ED, so be it. CPR would be the least you could do.

Does anyone think this story might end up being the impetus for changes either in good samaritan acts of giving CPR and/or the practicality of CPR in general and the increase need of DNR discussion?
 
I wasn't aware that the Emergency resident forum had an identical thread. Sorry for double posting :oops:. But I see several parallels. One thing that was mentioned is that we don't know what caused her to go down in the dining hall of an independent living facility. I really appreciate the medical students and physicians here who have been on codes, it adds excellent perspective to the situation.

But since at the moment CPR is what comes to mind in the event of an acute arrest out of the hospital, why can't a facility that isn't licensed to provide medical care allow their staff to attempt CPR, regardless of their training? EMS can provide these instructions, as indicated by the recorded 911 call. Wouldn't this just take a simple swipe of the pen to see that the facility assumes no responsibility for outcomes of CPR? If she were to have gone down in a grocery store, would the employees be allowed to perform CPR while the EMS is en route? It irritates me that people can't react to these situations without the fear of either being fired or sued. I understand the litigious nature of our society, but acting as a good samaritan should cover instances such as these where we don't know what happened (assuming she did not have a DNR).

I'm not saying the nurse did anything criminal. In fact I would be surprised if this police investigation leads to her being charged. I am aware that residents of the independent living facility sign a form that says no medical attention is directly on-site and that no CPR shall be attempted by staff. It's due to liability issues. If she was DNR, doesn't matter what the policy is. But if she was not DNR, this policy prevented a trained nurse from performing CPR while waiting for EMS to arrive. If she died en route to the ED, so be it. CPR would be the least you could do.

Does anyone think this story might end up being the impetus for changes either in good samaritan acts of giving CPR and/or the practicality of CPR in general and the increase need of DNR discussion?

Considering she hadn't been hired in a nursing role, do we even know if she was up to date on her CPR certification? If she wasn't, then that's another whole layer of serious liability on top of the institution's policies.

And to more directly answer your questions - this sort of thing happens ALL the time. Just for whatever reason the journalist decided to write a story about this one. Thus I don't think any major changes are going to come about because of this story. However I will say that while I was working at my old job I became a part of a pilot program for a new, more comprehensive DNR that was specifically for use at nursing/independent living facilities. There are known problems with most current DNR's and the movement started years ago to make the process better.
 
It is not immoral to want to spare another person suffering - nobody wants to cause pain - but I believe that it IS immoral to stand by and choose death for another human being based on YOUR value judgements. In the absence of an advance directive (seems unclear in this case if there was one) who are you or I to say "what this person has in store for them should they survive is very unpleasant. I can't imgine them wanting that, so I will make no effort to help them"? It may not be what we would choose for ourselves, but we have no right to make that choice for another person.

If it turns out that there was a DNR, then fine. Case closed. But if there was not, then what the "nursing" staff at this facility did was choose certain death for another human being rather than a slim chance at life based on what? Scared to violate policy? Fine. Do as the 911 operator asked and hand the phone to a passerby or another resident.

In cases like this, if there is no DNR, I believe that morally we must err on the side of even a chance at life, regardless of what we might choose for ourselves or our loved ones.

IMHO.

Spoken like a true premed. Go get some experience with patients.
 
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Interesting policy at this "independent living facility". I kind of like it actually. Probably saved tax payers a couple hundred thou as well, and probably saved this lady from an agonizing few days/weeks in the ICU before being coded again. Feel bad for the lady, but who knows what really was happening when she went down, who knows what her health conditions were, and it sounds like she knew what she signed up for.

That being said, if the nurse really said "I'm feeling stressed", she does come off as a huge idiot.
 
While none of the news stories make it clear whether or not the patient was DNR, all the ones I have read make it quite clear that the lady's daughter is very happy that CPR was not performed.

Also, the difference in the discussion of this article here and in the resident forums is very interesting.

I think it says so much that the daughter is glad her mom didn't have CPR performed and was allowed to pass peacefully.

Where's this thread on the resident forums? I'd like to read it.
 
My school makes us spend a little time at a facility exactly like this during second year. The director told us there are hundreds to thousands of elderly people living in some of these facilities. A lot of them are DNR, and a lot of them aren't. Any DNR orders are located on their refrigerators in their apartments and in their records at the hospital...so when the people are in the facility's dining hall or wherever, the nurses have no clue who is DNR and who isn't. The facilities are certainly not going to risk resuscitating someone in their care who didn't want it and had a DNR order in place, so they inform everyone who signs up to live there that if they collapse at dinner/anywhere else, they will call 911 to provide treatment. Both the woman and her daughter accepted the reasons for that policy before moving in. The nurse didn't know or explain anything, and the reporter didn't bother to find out before blowing the story out of proportion.
 
My school makes us spend a little time at a facility exactly like this during second year. The director told us there are hundreds to thousands of elderly people living in some of these facilities. A lot of them are DNR, and a lot of them aren't. Any DNR orders are located on their refrigerators in their apartments and in their records at the hospital...so when the people are in the facility's dining hall or wherever, the nurses have no clue who is DNR and who isn't. The facilities are certainly not going to risk resuscitating someone in their care who didn't want it and had a DNR order in place, so they inform everyone who signs up to live there that if they collapse at dinner/anywhere else, they will call 911 to provide treatment. Both the woman and her daughter accepted the reasons for that policy before moving in. The nurse didn't know or explain anything, and the reporter didn't bother to find out before blowing the story out of proportion.

But reporters never do that?
 
Does it really matter if the lady had an official DNR? She actively chose to live somewhere she knew there would be no CPR if something happened. Perhaps she felt she didn't need to go through the bother of filling out a DNR form given where she lives. Her daughter is happy with the outcome, suggesting that everything turned out according to the lady's wishes

The other thread:
http://forums.studentdoctor.net/showthread.php?t=988616
 
It is not immoral to want to spare another person suffering - nobody wants to cause pain - but I believe that it IS immoral to stand by and choose death for another human being based on YOUR value judgements. In the absence of an advance directive (seems unclear in this case if there was one) who are you or I to say "what this person has in store for them should they survive is very unpleasant. I can't imgine them wanting that, so I will make no effort to help them"? It may not be what we would choose for ourselves, but we have no right to make that choice for another person.

In cases like this, if there is no DNR, I believe that morally we must err on the side of even a chance at life, regardless of what we might choose for ourselves or our loved ones.

IMHO.

We take an oath to do no harm and you will learn that there are worse things in life than death. CPR in an 80-something year old is almost always futile and causes a lot of unnecessary suffering, wasted healthcare expenses that could be better served, and is often not what someone would chose for themselves. Yes, some people have an extra 20 years of life left after they turn 80 but not after a cardiac arrest. Your ideas change about life and death as you get older. Most 20-somethings want CPR as life is just getting started. But as life goes on most 80 year olds would change their answer (that understand what CPR entails-breaking ribs, weeks on a vent, etc). They've lived their life and realize that quality is more important than quanity. Society has come to see death as a failure. There's nothing wrong with death, it's the natural progression of life.
 
It is not immoral to want to spare another person suffering - nobody wants to cause pain - but I believe that it IS immoral to stand by and choose death for another human being based on YOUR value judgements.
Let's just clarify something here: the nurse did not choose death for this woman. She chose inaction, which (based on survival rates of CPR in the field) was 97% likely to have been the same thing as if she had pursued full-court press.

The patient died of her body's own processes. No one "chose death" for her. They are fundamentally different concepts. I once saw a patient die in the operating room, and no one did CPR. He wasn't even a DNR (to our knowledge). Why? Because it would have been futile, based on our judgment. Not performing CPR in given circumstances is not the same thing as "choosing death."

I get both sides of this issue, what I don't get is why everyone is referring to 84 like it is this crazy old age. It's old, but not so old that a strong individual wouldn't have more years. My grandpa went into Afib at 83 after a small stroke. His doc told us he was strong and felt he had many healthy years ahead of him (he was still fit/active) He was resuscitated, recovered, went through OT and is 94 and living on his own fully coherent.
Um, a-fib is just an arrhythmia requiring medical therapy. It's completely different from someone whose heart completely stops, necessitating CPR. The expected outcomes are not even close to similar, and neither are the probabilities of success.

Unless it was known that she had a DNR order, it just seems like the natural course of action would be to assist an incapacitated human being.
...if I thought I had any reasonable chance at my actions resulting in a meaningful outcome.

I'm not saying I wouldn't have done CPR in this situation, because I probably would have, but the natural course of inaction could be inaction.
 
Agree with theprowler. CPR (done correctly) is a brutal assualt of a person in the attempt to save their life. It is not a decision that should be taken lightly, especially when outcomes are likely to be very poor.

Also just want to add that age matters a heck of a lot less then co-morbidities/health status.I'd give an 84 year old w/out significant comorbidities a better shot then a 65 year old with hypertension, CAD, prior MI, diabetes, etc.
 
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