Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was

Should We Allow the Ethics Committee to Step In When We Disagree with Decisions About Our Dad in the ICU?

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED”  I want to answer questions from one of my clients, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad is in the ICU and she is asking why the ICU doctors are aiming for DNR status for her dad in the ICU.

Why Are the ICU Doctors Aiming for DNR (Do Not Resuscitate) Status for My Dad in the ICU?

 You can also check out previous 1:1 consulting and advocacy sessions with me and Iyah here.

Part 1

Part 2

Part 3 

Part 4

Part 5

Part 6

Part 7

Part 8

Part 9

Part 10

Part 11

Patrik:  Well, I guess as a health professional myself, I guess, if you wanted to bring in the ethics committee, I do believe that the family would need to give consent to that step. So, I guess the question is, would the family give consent for you to refer that to the ethics committee?

Nurse Ron:  They don’t have to give consent for the ethics committee.

Patrik: Show us your policies around that, please.

Nurse Ron: I don’t know the exact policy on that. It’s just-

Patrik:  Well, then how can you make such a statement then? How can you make such a statement that-

Nurse Ron:   Because it’s a protocol that it would happen.

Patrik: Yeah. Then just show it to us and make it transparent. That’s all. If you have nothing to hide, just show it to us.

Ron: Show you what though? I’m not sure I understand what you’re saying.

Patrik: Yeah. So if you make a referral to the ethics committee, I’m sure you have to follow policies and procedures, and I’m sure that part of that is the family as the next of kin or the guardian to give consent to that.

Ron:  Well, if I’m correct, the ethics committee sits with the family. They don’t do it behind the family’s back.

Patrik: Sure. Sure. Yeah. Surely. Well, that’s not my experience, but it’s a very nice term to use for the ethics committee. My experience is very different. That’s all. I am talking-

Ron: Well, I haven’t had a lot of experience with them. So you have something I haven’t had.

Patrik: Right.

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Liza:    That is my concern also is that you guys, the ethics committee would not follow the protocols that they are telling us.

Iyah:  I don’t follow that.

Ron: I’m trying to understand.

Liza:   That they’re not fully disclosure involved in the agreements.

Ron:   I think I’ll try to find the ethics committee protocol.

Patrik:   Thank you.

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Ron:  They’re really hard to find, just because of the way, when we merged with San Melrose Hospital, it’s been nuts trying to find stuff. But we’ll work on it.

Patrik:   But at the end of the day, if the family decides not to consent to DNR (Do Not Resuscitate), that’s the end of it. I mean, it’s the family’s decision, not an ethics committee’s decision. I mean, it’s-

Dr. Shelby:  But if the family is divided, that’s when you bring an ethics, because they all have equal say, they all have a voice in this.

Patrik:  Sure. For sure. If the family’s divided, it’s different, I agree with that.

Dr. Shelby:   And right now, the family is divided. So I think it’s good to have their input and see how that can help. So that. But Liza, I didn’t follow your point about the ethics community not following protocols.

Liza: Well, I guess what I’m understanding from what Ron was saying is that the ethics committee will do… They’re only there to help support us to make a decision. But I’m concerned that they will override our decision and say what they believe is best as the ethics committee.

Iyah: I have that concern as well.

Dr. Shelby:  That’s not their role. Their role is to assess, be the patient’s advocate, given what they can find out, to weigh the different family’s perspectives, and to weigh the health information perspective.

Dr. Shelby:  And the law parts of things to figure out what would be the best path forward?

Liza:  Right. So what if we meet with the ethics committee and we’re still at the same spot?

Dr. Shelby:  I don’t know the answer. That’s why I want to bring them in. There will have to be a resolution one way or the other. So how that plays out, I don’t know.

Ron:  So to be completely honest with you, somebody in the family is not going to be completely happy, and that’s just the way family dynamics are. You know what I’m saying?

Liza: Right.

Ron:   If one of you can’t let go no matter what, then you may end up being upset for a while, because your other family members may not be able to come to terms with how you want.

Liza:  Right.

Ron:  And that has nothing to do with the hospital though. It wouldn’t be us choosing for you.

Liza:  Well, I don’t know that, because I understand that the hospitals do get insurance money for death and for diagnosis of death. So I understand there is insurance money involved with these types of protocols. So I’m not sure who I can really believe at this time. My understanding is that my siblings took my father … Because I want to put in contact, I was never contacted during this emergency. So it’s kind of out of my hands right now, and I have to just face what’s going on. And the thing is… I forgot my train of thought. I’m sorry. I just drew a blank.

Dr. Shelby:  Well, I’ll just say there is no financial benefit.

Liza:  Okay. I remember what I was saying. So my siblings took him to the emergency room with the intent of saving his life, not the intent of letting him die. I believe if they really wanted to let him die, they would’ve let him die at home. So that’s why I feel that it is fine for us to continue with the CPR (Cardiopulmonary Resuscitation), even though he is in such a suffering condition. I believe my siblings have his life in interest, not his death.

Ron:  Well, all of us do.

Liza:  Right. I understand. But what I’m saying-

Ron:  I’m not in healthcare… I’m not in healthcare to help people die.

Liza: Right.

Ron:  I’m in healthcare to help people get better. Unfortunately-

Liza:  Right. What I’m trying to say-

Ron:  Unfortunately… Right.

Liza:  What I’m trying to say, Ron, is just my two siblings are split. I feel they need to reconsider what they’re thinking. I don’t feel that they are looking at everything objectively and doing all that they can to understand what’s going on. I feel that they are trying to make a decision for my father based on what they perceive as what he would want.

But the truth is we don’t really know what he wants, and I feel that he wants to stay alive. I really do feel that he wants to stay alive. And I thought about this a lot. And I’m okay if he passes away, but I do feel that he wants us to do whatever we can to support him to live as long as he can, even if he has to suffer a little bit. He’s going to suffer no matter what. That’s the truth. And I feel that if we can do whatever we can, we can at the end of the night realize that we have done all that we can. And from there, if he does decide to pass away, then we’ll feel comfortable knowing that we did all that we can and extend-

Ron:  So then-

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Liza:  … it just a little bit more time for us to reach that understanding.

Ron:  Liza, what does it mean to you that he passed away? What does that mean? How does that happen to him?

Liza:  Well, what it means to me is that I won’t be able to see his physical body anymore.

Ron:  No, I mean, the literal actual act of dying. What is that? I mean, if his heart stops, that’s dying. So that’s why we talk about it.

Liza:  Right.

Ron:  So I’m not understanding what you’re saying, and I’m trying to understand you.

Liza:  Right. So I guess I don’t have a very good grasp of cardiac arrest, and that really… So in most cases when people have cardiac arrest, do you just let them die?

Ron:  Cardiac arrest is the heart actually stopping. When the heart stops, the body is officially considered dead.

Liza:   Right. I understand that. And so we have…

Dr. Shelby:   So when that happens, CPR is a default intervention. But in some cases, it’s far less effective than it is in other cases. So we try to weigh the risks and benefits of all interventions. And especially in the ICU when there’s a higher chance of that stuff happening, we really try to figure out if the benefit outweighs the harm.

Liza:  Right.

Dr. Shelby:    And it’s less clear cut when someone’s really sick.

Liza:  Right. I understand now. I do feel that it is worth it too. I mean, it’s just some broken bones. He is already hurting. And if it can help him live a little bit longer and see if things can improve more, I feel that he would want that.

Dr. Shelby:  Thank you. So we’ll take all this into consideration and reach out to ethics and have them weigh in. I’ll document all this in my note for today, they can use as our reference guide too. And we’ll go from there. So let’s adjourn because it’s been a long time.

Ron:  Yeah. I got to get back to taking care of your dad. But rest assured Liza, we are not changing the code right now. He is full code.

Liza: Okay.

Ron: Okay. Okay.

Dr. Shelby: You guys know how to reach out to us? Gave you our card.

Michael:  Thank you.

Dr. Shelby:  We’re open seven days a week. That’s my name. I’m not here every day, but our team is here seven days a week.

Michael:  Thank you, Dr. Shelby.

Liza:  And how can I get in touch with you guys?

Iyah:  Thank you, Dr. Shelby.

Ron:  I’m going to put in a note to him.

Iyah:  All right.

Ron:  Okay.

Liza:  Thank you.

Ron:  You’re so welcome.

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Iyah:  Hey, Patrik.

Patrik:   I’m here. Can you talk freely?

Iyah:  Yeah.

Patrik:  Okay, good. So look, you haven’t agreed to DNR, which is good. I would have to explain a lot more around that. With the ethics committee, I would try and keep them out.

Iyah:  Yes, keep them out.

Patrik:  I would try and keep them…

Tim:  You’re just getting in?

Iyah:  No, I was at a meeting.

Tim:  Oh, you were at a meeting.

Iyah:  I’m sorry, Patrik. I was trying to get my way out. What was that?

Patrik:   I would try to keep the ethics committee out. They will do more harm than good. The ethics committee is a euphemism for a death panel. That’s what it.

Iyah:  Yeah. I can see that.

Patrik:  And it’s a very nice word. And they’re saying, “Oh, yeah, they will side with the family.” They’re hospital employees.

Iyah:  Yes.

Patrik:  They’re a hospital. It’s a whole lot of non sense, excuse my language, but that’s how strongly I feel about this. And I still believe that there is a hospital policy. They can’t just bring in the ethics committee, because they can see you’re not playing their game.

Iyah:  Yeah.

Patrik:  They can see you’re not playing their game. So now, they want to bring in the ethics committee, and I say, “Well, you don’t agree to that.” And if they can just do it as they say they can, well, there must be a policy around that. Everything in a hospital has a policy. Everything.

Iyah:  Yeah.

Patrik:  From cleaning the windows to mopping the floors, everything has a policy, including when to bring in an ethics committee.

Iyah:   Correct.

Patrik:  Right. So with him saying, “Oh, yeah, they will just help the family,” it’s just a whole lot of nonsense. If they did that, that would be the first ethics committee that I see helping the family.

Iyah:  I agree. My battery’s at 1%.

Patrik:  Yeah, yeah, sure. I get that.

Iyah: Can we continue the conversation in maybe five minutes or 10 minutes so I can plug in?

Patrik:  We probably need to set up another call later today.

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Iyah:  Yeah.

Patrik:  I need to run for now.

Iyah:  Totally fine. Yeah. What’s-

Patrik:  Can I get back to you-

Iyah:  … your availability?

Patrik:  Probably around eight o’clock.

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Iyah:   Sounds good.

Patrik:  Yeah. Let’s aim for eight o’clock.

Iyah:   Sounds perfect.

Patrik:  Okay.

Iyah:  Thank you so much, Patrik.

Patrik: Thank you so much. Thank you. Bye. Bye.

Iyah:  Have a good day.

The 1:1 consulting session will continue in next week’s episode.

Kind regards,

Patrik

I only have one consulting spot left for the rest of the week, if you want it, hit reply to this email and say "I'm in" and I'll send you all the details.