Officiously to keep alive

In West Palm Beach, Fla., a jury has held a nursing home liable for resuscitating a 92-year-old Alzheimer’s patient who had signed an advance directive indicating that she did not want to be kept alive by artificial means. And although an obstacle to even an otherwise well-founded “wrongful resuscitation” case might be the question of damages, the jury in this case awarded the estate of Madeline Neumann $150,000. (Rebecca Riddick, “Fla. Nursing Home Faulted for Ignoring End-of-Life Wishes”, Daily Business Review, Mar. 20; CourtTV coverage). An attorney for the physician defendant (who, unlike the nursing home, was found not liable in the case) said that despite do-not-resuscitate orders, medical personnel often make a judgment that a patient could potentially benefit from rescue efforts, and that had they failed to make such an effort in Mrs. Neumann’s case they might have faced legal risk: “If you call 911, you get sued,” he says. “If you don’t call, you get sued.” (Laura Parker, “In a crisis, do-not-revive requests don’t always work”, USA Today, Dec. 19, 2006).

8 Comments

  • Unless each patient is going to wear their resuscitative status attached to their body in a manner that could never be lost, mis-labeled or otherwise be incorrect, then one will have to err on the side of ‘resuscitate first, ask questions later’. The window of opportunity for successful resuscitation is vanishingly short, with seconds ticking away probability of success. The ability to end resuscitative or intensive care when it is found contrary to patient wishes is well established in the medical world; it is of course the specific remedy for unwanted resuscitation.

  • Gosh. And without resuscitation, how will she ever live long enough to spend it all?

  • The case was filed in 1997.

    Not exactly a home run for the plaintiff’s lawyer.

    $50K for 10 years of legal work?

  • Sounds like a bad situation. Legally, what can you do to make sure that your wishes are respected amid everyone’s lawsuit paranoia? I have a living will, an advance directive, and conversations about each have taken place with the spouse and the family. Is even that not enough?

  • Lisa: Get “DNR” tattooed on your chest in 5-inch high block letters?

  • Unless each patient is going to wear their resuscitative status attached to their body in a manner that could never be lost, mis-labeled or otherwise be incorrect, then one will have to err on the side of ‘resuscitate first, ask questions later’.

    The DNR request will normally be written on the patient’s chart, with which not only her physician but the floor nurses should be familiar. Accidental resuscitation as a result of ignorance of the DNR order should not happen very easily or often.

  • Was any untoward motive held by the nursing home discussed?

    I mean does the nursing benefit financial from a patient who is resucitated but requires treatment (extensive or not) at a hospital?

  • Frankly, I’m not certain that the tattoo ‘DNR’ would help. Given its permanance it is quite possible that if the individual had changed their mind, that the tattoo would still be there. If I saw such on a patient’s chest and had no prior substantiating information, I would continue resuscitation until the meaning of the tattoo could be discerned. That is, is it intended to be a true and currently valid DNR statement or is it the guy’s initials (my med-school roommate had those initials and he would no doubt not wish there to be any confusion relating to his health care)