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Tue Apr 21 18:56:16 BST 2009

I hate to say this, but it goes deeper than that.  In fact, I believe that our failure to reach a DNR order actually stems from those of us - the physicians - who cannot use the "D" word.  Death is inevitable, and at times it comes sooner than we want, and at times we have had a hand in it.  Regardless, it happens, and we are obliged to help our patients and their families accept that fact.  Futility by any other word is futility, and we must have the moral and ethical integrity to accept that, and when appropriate, be prepared to stop, even in the fact of overwhelming opposition from family members who "want everything that can be done" to be done.

Just my 2 cents on a grey and rainy day in the northeast.....

Ron
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jedidiah Peterson
Sent: Tuesday, April 21, 2009 12:38 PM
To: Trauma and Critical Care mailing list
Subject: Re: DNR policy

I am just going to jump in enough to say, from a nursing perspective, that I
have seen too many "modified DNRs" that just don't make sense. When we
treat resuscitation guidelines like an ala carte menu, we erode our position
of expertise and guidance.
For example, when the provider orders "Medications but no compressions" I
have a hard time believing that the burden for "informed consent" was
reached. Keeping in mind that we are talking about a pulseless patient,
medicating the basilic vein does little to improve outcomes. We know that.
Perhaps we have underexplained comfort measures.

If I were able to design the form, I would steer more towards a table
d'hote, with choice of "All Efforts", "Limited Efforts" or "Comfort
Measures" with each explained for clarity.

jed
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