Monday, November 20, 2017

Doctors and Hospitals are Placing Secret DNR Orders in Patient’s Files

At Right to Life of Michigan we’ve been flooded with a rash of calls and requests lately of a most disturbing nature. Patients and their families are finding themselves subject to Kafka-esque actions designed to take aware their autonomy and wishes—with deadly effect.
Jack Lessenberry, Michigan Radio’s senior political analyst, has written an article claiming legislation we’re working on to fix these issues are some sort of fundamentalist religious plot to force patients to stay hooked up to machines forever. He wistfully recalls the days of “Dr. Death,” Jack Kevorkian, killing patients across Michigan.

In his article he quotes an ethicist from GVSU [Grand Valley State University], Dr. Jeffrey Byrnes:
House Bills 5075 and 5076 and SB 597, are being sponsored and pushed by the religious right, primarily Right to Life of Michigan. They are billed as being written to stop abuses, to stop hospitals and doctors from forcing people to die without their consent. But that’s not what’s really happening.
As Dr. Byrnes put it, “Such a bill would allow for a family member – even a family member who had no real concern for their relative’s wishes or well-being – to keep the patient alive for an indefinite period of time.”

What is the real purpose of these bills? They address two distinct problems.

First is the practice of secret do-not-resuscitate orders being placed in patient’s files. Secret DNR orders are just plainly wrong, and it’s wrong for Lessenberry to frame his piece around patient autonomy when he seeks to defend the practice of patients being deceived about the care they expect.

The second problem is equally troubling. We’ve learned that some hospitals are going behind the backs of patients’ families and legal patient advocates to obtain secret court orders to establish guardianship over patients. Family members are showing up at the hospital only to discover hospital staff have taken control over their loved one to end their life.

That is an indefensible abuse of our court system. Secret court proceedings resulting in life or death decisions belong in Soviet Russia, not an America with robust constitutional protections. Patients have a right to have someone defend their life.

The bills would require hospitals to notify family members that they intend to go to court. In addition, the bills would require the doctor or medical facility to prove by clear and convincing evidence that the patient advocate or family is not acting in the best interest of the family before a guardian can be appointed. They also create a standard that assumes it is in the patient’s best interest to be alive, and the hospital has to prove otherwise before taking control of the patient.

There is a creeping assumption in our society that the sick and disabled are better off dead, and some courts are making that the controlling presumption. The default presumption should be that a special case should be required for hospitals to take over a patient’s autonomy to end their life.

There really are situations where a patient’s family is being unreasonable or a patient advocate is violating the patient’s wishes, and hospitals have a duty in those cases to represent the patient’s interest in court. Those situations must be handled in the light of day in a fair court process, however, not railroaded through a star chamber court in the dark.

Dr. Byrnes exposes his real concern, that patients will be in control of their own care, not him:
True, there may be some possibility of abuse today. But he said, “Medical cases in these situations are immensely complicated and can’t be addressed by the simplistic wording” in these bills. He told me [Lessenberry] they would “stop doctors and hospitals and clinical ethicists like myself from being able to stop treatment.”
How could you trivialize abuses like secret court proceedings and secret DNR orders? These are not trivial issues, nor are they complicated. The purpose of a guardianship hearing is to sort out care conflicts, not to rubber-stamp cost-cutting measures that sacrifice patients’ lives.

One of our own staff members directly experienced this, when her conscious father who was asking to be treated discovered the hospital had given up on him and placed a DNR order in his file without his request. What about Bob’s wishes and autonomy? Are death wishes the only ones that count? You can pick whatever treatment you like as long as it’s no treatment at all?

The purpose of these bills is not to let family members keep patients alive indefinitely, as Mr. Lessenberry falsely claims here. Patients do have a right to refuse unwanted medical treatment, and that right should be equally as important as patients who want medical treatment. The purpose of these bills is to prevent hospitals from deception and unjust violations of due process designed to end a patient’s life against their will.

Lessenberry writes, “Many of us want some element of control over our final destiny…”

That’s precisely our point!

As we’ve begun working on these bills and publicizing these cases, we’ve discovered a vast undercurrent. Many believe hospitals will abuse their power to mistreat patients in service of cost cutting concerns. Many of these cases and examples are egregious and have never been publicized. For whatever reason many people don’t believe anyone will speak up for them on this issue, and that there’s nothing they can do about it. That’s about to change.

We’ll see how the broader hospital establishment confronts these proposed change in the law, and if any changes are needed in the legislation as it moves forward, but we ask Mr. Lessenberry and Dr. Byrnes this: are secret DNR orders and secret court orders really the hill you want to die on? What sort of message will that send to an already cynical public?

Full Article & Source:
Doctors and Hospitals are Placing Secret DNR Orders in Patient’s Files


Steve said...

Someone needs to reign hospitals in. Too much power.

StandUp said...

This is the most sickening thing I've read in a while. Thank you for exposing it. Those doctors should all be charged with a crime!

Carolyn Anderson said...

I feel my blood pressure rising

Keith Story said...

I actually believe I had a similar circumstance myself yesterday. I forced the matter last night & today with my own mother in a major hospital system in Pennsylvania. My mother was admitted to a hospital for potential cardiac care & potential other unknowns, (not cancer), & transferred to one of the main hospital center's facilities. While visiting her as she was continuing to be monitored as she was scheduled for more tests to be done today & tomorrow, I asked her if she or my step-father made sure to provide a copy of the "Healthcare Treatment Instructions In The Event Of End-Stage Medical Conditions Or Permanent Unconsciousness" as is standard policy in our families, as no one wants to be maintained in those situations. Both stated that in the excitement, both had reportedly failed to give updated copies, because they were similar to prior, which they have used many times & expected that the doctors & hospital system still had copies (provided many times previously) believing they were in their electronic database or in their patient paper files. She said they asked if she wanted DNR applied to current patient file as they admitted her, again thinking they would follow prior paperwork copies directives. No, they reportedly did not do anything but put a blanket DNR in the electronic file, nor state that they once again reportedly did not maintain on file.

"UNDERSTAND THAT BLANKET DNR MEANS NO ATTEMPTS WILL BE MADE TO RESUSCITATE FOR ANY REASON"!!!! As a son with legal authority to address, (in absence but in agreement with my step-father's understanding), I had the hospital staff come in to fully explain to my mother what her her BLANKET DNR meant, even though I already knew it was contrary to Healthcare Treatment Instructions which we had updated by their family attorney this past summer. With older people who continue to have pride in attempting to control their own lives as possible, I gave her the respect of allowing her to realize their was a lack of proper explanation to her. After my mother realized that the matter was not properly explained, & that they were not following even her prior Healthcare Treatment Directives, my mother agreed to have me direct the hospital staff to correct in the system immediately yesterday, with additional hospital administration follow-up today. Unknown at the time of my express concern to get immediately handled in general terms, she had a test done today which created a medical urgency issue, & response from hospital staff, which could have possibly have become a fatal one, if I had not forced the matter last night. Luckily she recovered to be able to sit up & FaceTime Video through my IPhone with some of her grandchildren, & great-grandchildren in state & out of state this evening while my wife & I sat with her while giving my step-father time to rest up from the medical ordeals the last couple of days.