Can Anesthesiologists refuse to work a case for any reason?

[chocomorsel]

Ethics and Risk should be involved in such decisions

In an emergency? On a Saturday night? Where do you find these people? Are they on speed dial somewhere?

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[Angus Avagadro]

So did the blood save Grandma? Sounds like the point of no return at that point. Total BS.

Nope. It didn't
She had an AVR MVR, bleeding post pump, cold, widened QRS, brought in family to say goodbye. They panicked and we were told to transfuse her only to have her die shortly thereafter . That was when I stopped taking care of them for elective cases. What was the point of that???

 

[coffeebythelake]

In an emergency? On a Saturday night? Where do you find these people? Are they on speed dial somewhere?

You are right. They aren't available 24/7, but jf this happened at 2pm on a Tuesday... it'd be nice to have them opine on this

 

[chocomorsel]

Nope. It didn't
She had an AVR MVR, bleeding post pump, cold, widened QRS, brought in family to say goodbye. They panicked and we were told to transfuse her only to have her die shortly thereafter . That was when I stopped taking care of them for elective cases. What was the point of that???

You were bold to take her to the OR for such a big procedure without blood.
Ballsy. But you learned your lesson.
Unfortunate that you wasted all that precious blood.

 

[Angus Avagadro]

You were bold to take her to the OR for such a big procedure without blood.
Ballsy. But you learned your lesson.
Unfortunate that you wasted all that precious blood.

Actually my Chairman did the case. He didnt want any of us to take it. I was running the board that day and was privy to the details.

 

[anbuitachi]

what if your employer decide to put you in a difficult spot, which increases legal risk and possibly decrease care? can anesthesiologist decide to not do it other than quit. or will anesthesiologist be legally responsible for not doing the emergency case?

example: employer starts a level 1 trauma service and obviously will need anesthesiologist to be part of it. now all of a sudden, as a employee on call you now have to cover level 1 trauma, and busy OB service. anesthesiologists tell admin its not safe, but they continue the start of level 1 trauma anyway, they give salary fund to hire 1 additional anesthesiologist to cover. so i guess in this situation since the admin is deciding to move forward, all the responsibility falls on anesthesiology department to make this work? can the attendings even decide not to staff the trauma service without being legally responsible...

 

[chocomorsel]

Actually my Chairman did the case. He didnt want any of us to take it. I was running the board that day and was privy to the details.

You are smart.
Some of these chairmen and women hardly do cases especially in academics. Yours is a different breed.

 

[chocomorsel]

what if your employer decide to put you in a difficult spot, which increases legal risk and possibly decrease care? can anesthesiologist decide to not do it other than quit. or will anesthesiologist be legally responsible for not doing the emergency case?

example: employer starts a level 1 trauma service and obviously will need anesthesiologist to be part of it. now all of a sudden, as a employee on call you now have to cover level 1 trauma, and busy OB service. anesthesiologists tell admin its not safe, but they continue the start of level 1 trauma anyway, they give salary fund to hire 1 additional anesthesiologist to cover. so i guess in this situation since the admin is deciding to move forward, all the responsibility falls on anesthesiology department to make this work? can the attendings even decide not to staff the trauma service without being legally responsible...

Your job sounds absolutely horrendous and seems to get worse with each and every additional post.

 

[anbuitachi]

Your job sounds absolutely horrendous and seems to get worse with each and every additional post.

Oh that's not my job, just hypothetical situation!

 

[chocomorsel]

Oh that's not my job, just hypothetical situation!

Oh yeah. Sure.

 

[zizzer]

Jehovah's Witness for non emergent surgery with potential for heavy blood loss. Would have someone else do the case. Hemipelvectomy, liver resection etc. Plenty of people would allow them to bleed to death, I would not.

I have a major problem with this as well, but from what I've seen in residency, nobody even questions doing these without transfusing blood regardless of if the patient is going to die. I'm now a new attending in a decently sized private practice group. Should I just request a case switch if I'm assigned to something elective like this?

 

[Angus Avagadro]

I have a major problem with this as well, but from what I've seen in residency, nobody even questions doing these without transfusing blood regardless of if the patient is going to die. I'm now a new attending in a decently sized private practice group. Should I just request a case switch if I'm assigned to something elective like this?

I never had a problem finding someone to switch an elective case. Refused to do a c section for the 5th child. 5% incidence of placenta accreta with each section. So 20% chance of section/hysterectomy. If you have never lived through one of these, they are a blood bath and require transfusions once a surgeon arrives to bail out the OBGyn. I could not live with myself letting the mother of 5 children bleed to death. She underwent an uneventful section/ tubal. I'm grateful it all worked out.

 

[Arch Guillotti]

I never had a problem finding someone to switch an elective case. Refused to do a c section for the 5th child. 5% incidence of placenta accreta with each section. So 20% chance of section/hysterectomy. If you have never lived through one of these, they are a blood bath and require transfusions once a surgeon arrives to bail out the OBGyn. I could not live with myself letting the mother of 5 children bleed to death. She underwent an uneventful section/ tubal. I'm grateful it all worked out.

I don't get it. Why are you punting high risk cases? Nobody likes doing them.

The cesarean hysterectomies I have seen did not involve a general surgeon.

 

[Angus Avagadro]

I don't get it. Why are you punting high risk cases? Nobody likes doing them.

The cesarean hysterectomies I have seen did not involve a general surgeon.

I'm not punting high risk cases. They never bothered me. The c section was a Jehovah's witness, so was the hemipelvectomy, which I did, and the AVR/MVR was also a Witness. Just in response to the question" Can anesthesiologists refuse to do a case". I didn't care for Witnesses for elective cases. Your OBGyns are obviously better than ours were. Any section hyster I was involved with was a 5 to 10 unit case.

 

[2Fast2Des]

I never had a problem finding someone to switch an elective case. Refused to do a c section for the 5th child. 5% incidence of placenta accreta with each section. So 20% chance of section/hysterectomy. If you have never lived through one of these, they are a blood bath and require transfusions once a surgeon arrives to bail out the OBGyn. I could not live with myself letting the mother of 5 children bleed to death. She underwent an uneventful section/ tubal. I'm grateful it all worked out.

Umm... I'm not sure this is a case that's punt-able, this is like another day in OB, especially when it comes to the Orthodox religious women whose sole purpose to procreate. High risk yes, controversial, no... Unless she's a Jehovah's then give her the run down... You can explain to her that risk of orphaning her children, and see if that's an acceptable risk vs eternal damnation. Just another day at work.

 

[Angus Avagadro]

Umm... I'm not sure this is a case that's punt-able, this is like another day in OB, especially when it comes to the Orthodox religious women whose sole purpose to procreate. High risk yes, controversial, no... Unless she's a Jehovah's then give her the run down... You can explain to her that risk of orphaning her children, and see if that's an acceptable risk vs eternal damnation. Just another day at work.

It was an elective repeat section and she was a Witness, sorry if I didnt make that clear. I only punted Witnesses for elective cases that could require transfusions. Not a carpal tunnel, etc. I never had a problem switching with an associate. Emergencies as I said earlier were different. I wouldn't call in a partner to do that.

 

[Arch Guillotti]

It was an elective repeat section and she was a Witness, sorry if I didnt make that clear. I only punted Witnesses for elective cases that could require transfusions. Not a carpal tunnel, etc. I never had a problem switching with an associate. Emergencies as I said earlier were different. I wouldn't call in a partner to do that.

Why do you punt them? Serious question.

 

[coffeebythelake]

I'm not punting high risk cases. They never bothered me. The c section was a Jehovah's witness, so was the hemipelvectomy, which I did, and the AVR/MVR was also a Witness. Just in response to the question" Can anesthesiologists refuse to do a case". I didn't care for Witnesses for elective cases. Your OBGyns are obviously better than ours were. Any section hyster I was involved with was a 5 to 10 unit case.

You think some other anesthesiologist would love to deal with this? Or that they are a sociopath and perfectly ok letting a patient bleed to death because they are JW? There is no moral or ethical dilemma here. The JW patient is made aware of risks, including death, and they decide it is acceptable risk. You deal with this not so palatable situation but you do it. You can ask for guidance from colleagues if you want. Plan strategies to minimize blood loss and clarify what products if any the patient is willing and unwillijg to receive. To outright refuse is punting, and you pretending you are somehow different from anyone else you punt this to is BS.

bottom line you are too afraid to deal with thr case and its consequences so you let someone else do it. Your fellow anesthesioligsts probably talk **** behind your back.

 

[Arch Guillotti]

You think some other anesthesiologist would love to deal with this? Or that they are a sociopath and perfectly ok letting a patient bleed to death because they are JW? This is absolutely punting, and you pretending you are somehow different from anyone else you punt this to is BS.

bottom line you are too afraid to deal with thr case and its consequences so you let someone else do it. Your fellow anesthesioligsts probably talk **** behind your back.

That was a little rough. But I would like to know the reason for the punt.

 

[coffeebythelake]

That was a little rough. But I would like to know the reason for the punt.

I have been personally on the receiving end of many such punts. Nobody likes to do them. Sorry if it seems I wrote so forcefully.

 

[Arch Guillotti]

I have been personally on the receiving end of many such punts. Nobody likes to do them. Sorry if it seems I wrote so forcefully.

No worries.

 

[chocomorsel]

You think some other anesthesiologist would love to deal with this? Or that they are a sociopath and perfectly ok letting a patient bleed to death because they are JW? There is no moral or ethical dilemma here. The JW patient is made aware of risks, including death, and they decide it is acceptable risk. You deal with this not so palatable situation but you do it. You can ask for guidance from colleagues if you want. Plan strategies to minimize blood loss and clarify what products if any the patient is willing and unwillijg to receive. To outright refuse is punting, and you pretending you are somehow different from anyone else you punt this to is BS.

bottom line you are too afraid to deal with thr case and its consequences so you let someone else do it. Your fellow anesthesioligsts probably talk **** behind your back.

Why the need to be so mean in your response?
Truth is, there are some sociopathic anesthesiologists out there who wouldn’t be bothered if someone dies due to refusing blood. Or for whatever reason they aren’t bothered like others.

So yeah, if you got those in your group, and it bothers you to watch someone die that could have lived with a transfusion, why not “punt” it as you call it?
We are all a team and some people have strong points others don’t.
I don’t see anything wrong with what @Angus Avagadro is doing.

 

[chocomorsel]

I have been personally on the receiving end of many such punts. Nobody likes to do them. Sorry if it seems I wrote so forcefully.

You are more than welcome to say no from your end if you weren’t assigned to it.

 

[Angus Avagadro]

Why do you punt them? Serious question.

Personal ethics I guess. I couldn't abide losing a patient that I could easily have saved wirh a transfusion. Plus, as you have seen from earlier posts, I have witnessed some cases turn into a sh!!t show, where once the patient was near death, the family transfused them, only to have them expire shortly thereafter. The AVR/MVR I mentioned. It's the patients right I suppose to set the parameters, I choose not to participate if I can punt. Fortunately for me, the majority of my partners didn't feel the same way. Hope this helps explain my actions.

 

[Angus Avagadro]

You think some other anesthesiologist would love to deal with this? Or that they are a sociopath and perfectly ok letting a patient bleed to death because they are JW? There is no moral or ethical dilemma here. The JW patient is made aware of risks, including death, and they decide it is acceptable risk. You deal with this not so palatable situation but you do it. You can ask for guidance from colleagues if you want. Plan strategies to minimize blood loss and clarify what products if any the patient is willing and unwillijg to receive. To outright refuse is punting, and you pretending you are somehow different from anyone else you punt this to is BS.

bottom line you are too afraid to deal with thr case and its consequences so you let someone else do it. Your fellow anesthesioligsts probably talk **** behind your back.

I was never afraid to do any case. I have a right to reject the parameters a patient places on me. By doing so, I have to find them a competent replacement. My associates didn't share my concerns to the same degree as I did with Witnesses. So it worked for everyone. Punting implies my partner was reassigned the case. It was never like that. It was always at my request to switch and they could have declined. It was their choice. As far as anyone talking behind my back, I could care less.

 

[Arch Guillotti]

why not “punt” it as you call it?

Because it means someone else has to deal with a crappy case that you can’t be bothered with.

 

[chocomorsel]

Because it means someone else has to deal with a crappy case that you can’t be bothered with.

They can always say no. If you mean it’s done by force, that’s not what he or she is saying. Or what I am saying either.
He’s asking someone more willing or unbothered to switch.
And it’s not about “being bothered with”. It’s about having the ethics of it all not aligned with yours.
Y’all must be some hard asses with ice cold blood running through your veins. Y’all are the ones I would ask to do this case.

 

[chocomorsel]

I was never afraid to do any case. I have a right to reject the parameters a patient places on me. By doing so, I have to find them a competent replacement. My associates didn't share my concerns to the same degree as I did with Witnesses. So it worked for everyone. Punting implies my partner was reassigned the case. It was never like that. It was always at my request to switch and they could have declined. It was their choice. As far as anyone talking behind my back, I could care less.

We are supposed to apparently be willing to do anything and everything that comes our way even if certain cases don’t align with our beliefs and ethics. Or do stupid stuff that potentially could end up in court.

That’s one of my reasons for not doing a case like this. After separating them from their family first that is. Not interested in potentially getting dragged to court.

Taking a Jehovas witness to a CV OR for an open heart is stupid to me. But not to others apparently. Our group refused to do a scoliosis case on a kid who’s parents were JW. Hell to the no. That’s abuse IMO. But someone in town did it. Not me! Punt away!!!

 

[zizzer]

You think some other anesthesiologist would love to deal with this? Or that they are a sociopath and perfectly ok letting a patient bleed to death because they are JW? There is no moral or ethical dilemma here. The JW patient is made aware of risks, including death, and they decide it is acceptable risk. You deal with this not so palatable situation but you do it. You can ask for guidance from colleagues if you want. Plan strategies to minimize blood loss and clarify what products if any the patient is willing and unwillijg to receive. To outright refuse is punting, and you pretending you are somehow different from anyone else you punt this to is BS.

bottom line you are too afraid to deal with thr case and its consequences so you let someone else do it. Your fellow anesthesioligsts probably talk **** behind your back.

Many other anesthesiologists seem to view it totally differently. They're not sociopaths, but they think religion is a legitimate reason to refuse an available life-saving intervention. I am not religious and it seems no different than if a patient wanted their airway surgery done without a pulse oximeter or some other essential safety component because they have magical beliefs about them. It's ridiculous. I think Angus said it well by saying he has a right to reject the parameters placed on him by patients. Would you all do these elective cases without supplemental oxygen if a patient refused it with no good reason? Why blood transfusions then?

 

[Arch Guillotti]

We are supposed to apparently be willing to do anything and everything that comes our way even if certain cases don’t align with our beliefs and ethics. Or do stupid stuff that potentially could end up in court.

Like a c/s?

 

[chocomorsel]

Like a c/s?

Yeah, like a C/S, or any other case that could potentially lead to surgical or anesthetic complications/outcomes with a fixable solution that the patient is refusing.
The patient doesn’t dictate to me what he or she wants it it’s potentially detrimental to their health.
Any other questions? Scenarios? Gripes? Complaints?

Last I checked my job was to get patients through surgery safely. If I don’t feel it’s safe, I ain’t proceeding. Unless it’s an emergency and in that case, document, document, document and hope for the best.

Your opinion is not always “right“.

 

[IMGASMD]

Many other anesthesiologists seem to view it totally differently. They're not sociopaths, but they think religion is a legitimate reason to refuse an available life-saving intervention. I am not religious and it seems no different than if a patient wanted their airway surgery done without a pulse oximeter or some other essential safety component because they have magical beliefs about them. It's ridiculous. I think Angus said it well by saying he has a right to reject the parameters placed on him by patients. Would you all do these elective cases without supplemental oxygen if a patient refused it with no good reason? Why blood transfusions then?

Saw in a chart once that the patient is allergic to oxygen..... yep.

We have a “bloodless” program. Get the patients to have IV iron, sometimes epo, to get their numbers up. Also have some mechanism to get substitute blood (never used it nor seen it being used...).

Recently a partner did a bowel resection for colon ca. Patient end up losing a lot of blood did okay initially, Hgb 6. A day or two later, BRBPR, hgb4. Asked him before surgery if he will have transfusion. No minced words, “you will die” even if you survived surgery. Nope... Took him in, got him through, dead a few hours later.

 

[vector2]

Our group refused to do a scoliosis case on a kid who’s parents were JW. Hell to the no. That’s abuse IMO. But someone in town did it. Not me! Punt away!!!

I know that in urgent or emergent situations a JW parent cannot refuse blood on behalf of their children. I never really thought about semi-elective cases like this....I'm still thinking that even if the parents sign the scoliosis surgery consent but not the blood consent that the team can probably still give blood in a true emergency to a minor, but maybe that requires a court order first or something...

 

[chocomorsel]

I know that in urgent or emergent situations a JW parent cannot refuse blood on behalf of their children. I never really thought about semi-elective cases like this....I'm still thinking that even if the parents sign the scoliosis surgery consent but not the blood consent that the team can probably still give blood in a true emergency to a minor, but maybe that requires a court order first or something...

I think it’s all state dependent. And I know i have been peripherally involved in cases that involved a judge and court orders. Can’t remember details.

 

[chocomorsel]

Saw in a chart once that the patient is allergic to oxygen..... yep.

We have a “bloodless” program. Get the patients to have IV iron, sometimes epo, to get their numbers up. Also have some mechanism to get substitute blood (never used it nor seen it being used...).

Recently a partner did a bowel resection for colon ca. Patient end up losing a lot of blood did okay initially, Hgb 6. A day or two later, BRBPR, hgb4. Asked him before surgery if he will have transfusion. No minced words, “you will die” even if you survived surgery. Nope... Took him in, got him through, dead a few hours later.

What’s the point of even proceeding to surgery and wasting people’s time and hospital resources.
We need “death panels” for these patients.

 

[deleted126335]

Many other anesthesiologists seem to view it totally differently. They're not sociopaths, but they think religion is a legitimate reason to refuse an available life-saving intervention. I am not religious and it seems no different than if a patient wanted their airway surgery done without a pulse oximeter or some other essential safety component because they have magical beliefs about them. It's ridiculous. I think Angus said it well by saying he has a right to reject the parameters placed on him by patients. Would you all do these elective cases without supplemental oxygen if a patient refused it with no good reason? Why blood transfusions then?

Patients have a right to be stupid and make bad choices....up to a point. Where that point is depends on the individual clinician, institutional policy, and maybe state law.

 

[dannyboy1]

Patients have a right to be stupid and make bad choices....up to a point. Where that point is depends on the individual clinician, institutional policy, and maybe state law.

It is well established that JW have a right to refuse blood. That being said, if they are at high risk of needing transfusion, you need to be absolutely sure of their wishes, make sure the surgeon and nurse are there when you consent them, and not mince words (I.e you may die or suffer irreversible organ/neurological damage) and document the hell out of it. As far as I know minors cannot refuse blood but if you are in that situation you should certainly get legal/risk management involved.

 

[drmwvr]

Surgeons refuse to do cases all of the time. Had one in particular that the CT surgeon had replaced a MV in a young methamphetamine/ IVDU that blew out his replacement valve too and his function was in the teens. Showed up to the hospital with his works in is belongings bag. The guy demanded surgery. It was essentially suicide by surgeon. Our guy refused (with a lot of hand wringing and angst) but that was that.

 

[Angus Avagadro]

I know that in urgent or emergent situations a JW parent cannot refuse blood on behalf of their children. I never really thought about semi-elective cases like this....I'm still thinking that even if the parents sign the scoliosis surgery consent but not the blood consent that the team can probably still give blood in a true emergency to a minor, but maybe that requires a court order first or something...

If it is a minor, you can get a judge and a court order to transfuse them in our state.

 

[pjl]

Many other anesthesiologists seem to view it totally differently. They're not sociopaths, but they think religion is a legitimate reason to refuse an available life-saving intervention. I am not religious and it seems no different than if a patient wanted their airway surgery done without a pulse oximeter or some other essential safety component because they have magical beliefs about them. It's ridiculous. I think Angus said it well by saying he has a right to reject the parameters placed on him by patients. Would you all do these elective cases without supplemental oxygen if a patient refused it with no good reason? Why blood transfusions then?

Do you allow patients to be DNR in the OR, or in the hospital?

 

[Neopolymath]

I know that in urgent or emergent situations a JW parent cannot refuse blood on behalf of their children. I never really thought about semi-elective cases like this....I'm still thinking that even if the parents sign the scoliosis surgery consent but not the blood consent that the team can probably still give blood in a true emergency to a minor, but maybe that requires a court order first or something...

This is also my understanding as parental decision-making based on religion is completely nullified in life or death situations such as transfusions. The child did not choose religion... They are a child and do not understand the implications and can't be sacrificed because of their crazy parents. This was repeated ad nauseum in ethics questions and by our legal/ethics lectures in school.

As an aside, I guess I'm a sociopath because I really couldn't care less if a religious person dies from totally avoidable medical problems due to whatever flavor fairy tale they believe instead of all the other fairy tales. It's a waste of money and I think they are *****s but it's not my life. They have their right to die in this country. The only reason I would ever care is if this decision making affects someone dependent on said preventably dead person such as children.

 

[DrZzZz]

Do you allow patients to be DNR in the OR, or in the hospital?

Absolutely. As long as they understand that they may die a potentially avoidable death because of their DNR (or refusal of blood products if JW), that's their call. They have that right. Now, if it's a case that requires an ETT, I will make sure they understand that is part of the procedure they're agreeing to (and thus, reversing that part of the DNR for the case). But chest compressions and/or defib shocks are not part of the planned procedure so if they still want to refuse those, fine by me.

 

[deleted59964]

If a patient tells you that you will be sued for any bad outcomes. Yep, automatic cancellation from me. Someone else can do the case.

In all seriousness me too, because essentially they are not agreeing to give consent

 

[anbuitachi]

Absolutely. As long as they understand that they may die a potentially avoidable death because of their DNR (or refusal of blood products if JW), that's their call. They have that right. Now, if it's a case that requires an ETT, I will make sure they understand that is part of the procedure they're agreeing to (and thus, reversing that part of the DNR for the case). But chest compressions and/or defib shocks are not part of the planned procedure so if they still want to refuse those, fine by me.

do you allow your patients to get whatever type of anesthetic they want, if they understand the risks and benefits and consent to it?

your healthy patient wants GA for cataract with a tube, and is willing to take all the risks. etc

Wondering b/c ive told patients No before when they requested GA, especially for C sections.

 

[Aether2000]

Much depends on how the anesthesiologist's desired anesthetic choice is presented to the patient. The patients primary concerns are not feeling the pain of surgery and not remembering the surgery. We have several tools that will permit this, while using a regional or axial anesthetic, so by choosing the words carefully, it is usually possible to thread the needle between patient fears and best anesthetic. In my OR, patients do not have the right to maintain DNR status during surgery and in PACU, and this is waived by the patient, otherwise they do not need the anesthesia, and whatever surgery can be done under local. But again, how this is worded to the patient makes all the difference, and explaining the things we do to preserve life under anesthesia and DNR techniques overlap so much that one cannot tell the difference ameliorates patients resistance to waiving a DNR.

 

[IMGASMD]

do you allow your patients to get whatever type of anesthetic they want, if they understand the risks and benefits and consent to it?

your healthy patient wants GA for cataract with a tube, and is willing to take all the risks. etc

Wondering b/c ive told patients No before when they requested GA, especially for C sections.

Recently, hip refused spinal. Because they don’t want someone to stick a needle in their spine. Surgeon talked him out of it. I have no strong preference, since the patient is good.

C-section, that’s more debatable...... since it’s not just the patient’s outcome you’re worried about. I’ve done one GA recently for a scheduled case due to patient refusal. I would do it, especially with a competent ob, and has there been literature really saying that there is real outcome difference with GA? Document document document.....

 

[IMGASMD]

Double

 

[deleted126335]

Recently, hip refused spinal. Because they don’t want someone to stick a needle in their spine. Surgeon talked him out of it. I have no strong preference, since the patient is good.

C-section, that’s more debatable...... since it’s not just the patient’s outcome you’re worried about. I’ve done one GA recently for a scheduled case due to patient refusal. I would do it, especially with a competent ob, and has there been literature really saying that there is real outcome difference with GA? Document document document.....

One case I got written up for refusing about 15 years ago for was a PPTL. Patient had known and obvious difficult airway. Unpleasant experience with regional anesthesia in past and absolutely refused regional. I told her to come back in six weeks when a GA would be safer. Or take a spinal today.

 

[DrZzZz]

do you allow your patients to get whatever type of anesthetic they want, if they understand the risks and benefits and consent to it?

your healthy patient wants GA for cataract with a tube, and is willing to take all the risks. etc

Wondering b/c ive told patients No before when they requested GA, especially for C sections.

Within reason, yes. Refusing a spinal for a c-section is entirely reasonable in the absence of a horrific looking (or documented) airway, as long as the patient understands the risks. Forcing a spinal on someone that is refusing it is essentially assault. Same goes for a hip or knee, as someone mentioned above. As long as the alternative anesthetic is within reason, the patient can refuse certain things. Now, if they are asking for something ridiculous, that's another story.

 

[drmwvr]

Absolutely. As long as they understand that they may die a potentially avoidable death because of their DNR (or refusal of blood products if JW), that's their call. They have that right. Now, if it's a case that requires an ETT, I will make sure they understand that is part of the procedure they're agreeing to (and thus, reversing that part of the DNR for the case). But chest compressions and/or defib shocks are not part of the planned procedure so if they still want to refuse those, fine by me.

If the patient has that right, then anyone involved in their case has the right to object. There is no obligation to be an escort to someone's sure/probable demise at what amounts to the patient's own hand (JW etc). To suggest that there is no potential residual psychological effect on the persons involved is willfully ignorant of what we know about moral injury and psychological stress. If some are willing to take that on voluntarily or deny that is an issue for them, they can have at it.