I was wondering if, with the dismal likelihood of response to CPR in Covid and the real danger of contagion when administering CPR to a patient, if it is ethically justifiable offer it, and if not, then it is not a question of asking about DNR, but rather a discussion of why that will not be offered. Tom Reagan
Whether it is ethically justifiable not to offer CPR is probably a bit beyond the scope of my practice, but I do know that the framing of discussion in a manner of why CPR won't be offered is a common part of both my practice and the practice of many others I've worked with.
The term for this type of framing in the bioethics literature is "informed non-dissent" and it's a reasonable way to proceed in these challenging scenarios. The link below discusses this as an option
Thank you very much. I was not familiar with the term "informed non-dissent", but realize after reading about it that I have used it a number of times. The first time was in a discussion about a potential abortion in a 16 year old with severe enough hyperemesis gravidarum that the alternative was IV hyperalimentation back in the days when that would have been a several week hospitalization. Mother who was also experiencing hyperemesis supported the abortion but father could not bring himself to consent and we just told him that we would perform an abortion in 2 days and he could permit it to happen, but could not bring himself to consent to it. That was a powerful lesson to me almost 40 years ago but I had not seen the term until now. Bless you in your work, Tom Reagan
More on "informed non-dissent" and CPR. I was impressed with the ease of your use of "informed non-dissent" as an equivalent to consent. I think it is absolutely the right answer and gets around the brutality of asking someone to "sign on the dotted line". The signature may have some utility in terms of recognizing the situation as it is, but it is never comfortable. I have realized that my awkwardness with recognizing "informed non-dissent" as "consent" is probably age related, generational, or even a "Boomer" thing. I started practice when DNR orders were still considered suspect and perhaps illegal, and later was challenged by a hospital DOH survey nurse who ordered me to rescind a DNR because I had taken a properly witnessed verbal DNR consent without the patients signature. (I did not.) Again thank you for your care and intelligence. Tom Reagan
These situations are almost always challenging. There are both ethical and legal ramifications in any situation that isn't "straightforward" that we need to navigate. I think most providers are striving to do the right thing for the patient; family members generally are as well. But just because everyone has the same goal doesn't always mean it's easy to get on the same page with the specifics
I was wondering if, with the dismal likelihood of response to CPR in Covid and the real danger of contagion when administering CPR to a patient, if it is ethically justifiable offer it, and if not, then it is not a question of asking about DNR, but rather a discussion of why that will not be offered. Tom Reagan
Whether it is ethically justifiable not to offer CPR is probably a bit beyond the scope of my practice, but I do know that the framing of discussion in a manner of why CPR won't be offered is a common part of both my practice and the practice of many others I've worked with.
The term for this type of framing in the bioethics literature is "informed non-dissent" and it's a reasonable way to proceed in these challenging scenarios. The link below discusses this as an option
https://www.researchgate.net/publication/51764243_Informed_Non-Dissent_A_Better_Option_Than_Slow_Codes_When_Families_Cannot_Bear_to_Say_Let_Her_Die
Thank you very much. I was not familiar with the term "informed non-dissent", but realize after reading about it that I have used it a number of times. The first time was in a discussion about a potential abortion in a 16 year old with severe enough hyperemesis gravidarum that the alternative was IV hyperalimentation back in the days when that would have been a several week hospitalization. Mother who was also experiencing hyperemesis supported the abortion but father could not bring himself to consent and we just told him that we would perform an abortion in 2 days and he could permit it to happen, but could not bring himself to consent to it. That was a powerful lesson to me almost 40 years ago but I had not seen the term until now. Bless you in your work, Tom Reagan
More on "informed non-dissent" and CPR. I was impressed with the ease of your use of "informed non-dissent" as an equivalent to consent. I think it is absolutely the right answer and gets around the brutality of asking someone to "sign on the dotted line". The signature may have some utility in terms of recognizing the situation as it is, but it is never comfortable. I have realized that my awkwardness with recognizing "informed non-dissent" as "consent" is probably age related, generational, or even a "Boomer" thing. I started practice when DNR orders were still considered suspect and perhaps illegal, and later was challenged by a hospital DOH survey nurse who ordered me to rescind a DNR because I had taken a properly witnessed verbal DNR consent without the patients signature. (I did not.) Again thank you for your care and intelligence. Tom Reagan
These situations are almost always challenging. There are both ethical and legal ramifications in any situation that isn't "straightforward" that we need to navigate. I think most providers are striving to do the right thing for the patient; family members generally are as well. But just because everyone has the same goal doesn't always mean it's easy to get on the same page with the specifics