New Texas DNR law

[NITRAS]

We recently had a meeting with our legal department. A new Texas law went into effect requiring written consent within a reasonable amount of time. This is just kind of annoying, a couple different forms have come and gone.

The biggest deal is law also limits the people that can initiate and revoke a DNR. Only patient with capacity, legal guardian, or MPOA can initiate or withdraw a DNR unless the physician declares them irreversibly terminal in which case a surrogate decision maker can make them DNR (but can't revoke it).

I think its only a matter of time before an institution gets on the news for "killing grandma" because they couldn't revoke a DNR because they didn't have an MPOA. I hope our MICU teams (closed ICU) don't screw this up and leave us in an awkward position.

I don't usually consider the Houston Chronicle to be a considered legitimate news, but here is an article about it
New law limits doctors' ability to invoke DNR without patient consent

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[FutureInternist]

I am surprised to find out that this wasn't the law already.
Who else, but a mentally competent patient, legal guardian or MPOA could ever consent to or withdraw a DNR?
If someone is DNR, hopefully the documentation has their MPOA's contact info & if not, then in the absence of any contradictory info, the pt is DNR since the paperwork said so.
We all have likely seen cases of futile care, where we wish we could have made the pt DNR, but for me, the # of those cases just not justify unilateral DNRs w/o any informed consent whatsoever.

 

[rokshana]

I am surprised to find out that this wasn't the law already.
Who else, but a mentally competent patient, legal guardian or MPOA could ever consent to or withdraw a DNR?
If someone is DNR, hopefully the documentation has their MPOA's contact info & if not, then in the absence of any contradictory info, the pt is DNR since the paperwork said so.

in most states, the next of kin (NOK) can make those decisions, because most people don't have a MPOA done.

 

[FutureInternist]

in most states, the next of kin (NOK) can make those decisions, because most people don't have a MPOA done.

Is the NOK not automatically the MPOA in the absence of a designated one?
In NM, the paperwork allows for limits to be placed on the MPOAs authority so, as an example, they can agree/disagree to procedures, surgeries etc but cannot change the pt's wishes on feeding tubes, DNRs etc

"A survey published in the July issue of the journal Chest found half of responding doctors endorsed unilateral DNR orders as appropriate. Six percent of doctors and 20 percent of pulmonary critical-care doctors who responded said they had performed a unilateral DNR - that is, slipped an order in a patient's file or refused a request to provide CPR - in the previous year.

This part is just mind-boggling to me.

 

[NITRAS]

Nope. Next of kin is a surrogate descision maker. An MPOA is a legal document you must be competent to make at the time.

The articles talk about unilateral DNRs. I’ve never seen one.