DNR Order Against Patient Wishes

[Peetie]

What is the name of your state? New York

My mother recently passed away in a hospital. I am not yet sure of the cause of death (no death certificate yet) but the most likely cause is congestive heart failure.

She entered a hospital with a broken leg about one month ago, was operated on, suffered a heart attack while being transported to rehab, and taken to a 2nd hospital where she died about two weeks later. We were told at the 2nd hospital that she had congestive heart failure and fluids in her lungs from the congestive heart failure. She was being treated with lasix to remove the excess fluid and morphine for the pain (her leg). Her treatment was going well, with periods of restless sleep and other periods of conversation and even singing. She was lucid when she was awake.

My sister, as legal Health Care Proxy, signed a Do Not Resuscitate order which stopped my mother's active treatment (trying to improve her condition with the lasix) and began passive treatment (provide comfort with increased morphine until death - in nurse's circles, its called "snowing") which resulted in my mother's death approximately 24 hours after the signing.

The DNR order was against my mother's wishes. She knew she was going to die soon but repeatedly stated, in the presence of family and hospital staff, that she didn't want a DNR order, that she wanted to go home, that she wanted to see her grandchildren graduate school, that she wanted to meet my fiancee, etc etc.

Question: Can legal action be taken against my sister for the wrongful death of my mother based on the statements made by my mother while in the hospital, either civil or criminal?

[panzertanker]

Originally Posted by Peetie

What is the name of your state? New York

My mother recently passed away in a hospital. I am not yet sure of the cause of death (no death certificate yet) but the most likely cause is congestive heart failure.

She entered a hospital with a broken leg about one month ago, was operated on, suffered a heart attack while being transported to rehab, and taken to a 2nd hospital where she died about two weeks later. We were told at the 2nd hospital that she had congestive heart failure and fluids in her lungs from the congestive heart failure. She was being treated with lasix to remove the excess fluid and morphine for the pain (her leg). Her treatment was going well, with periods of restless sleep and other periods of conversation and even singing. She was lucid when she was awake.

My sister, as legal Health Care Proxy, signed a Do Not Resuscitate order which stopped my mother's active treatment (trying to improve her condition with the lasix) and began passive treatment (provide comfort with increased morphine until death - in nurse's circles, its called "snowing") which resulted in my mother's death approximately 24 hours after the signing.

The DNR order was against my mother's wishes. She knew she was going to die soon but repeatedly stated, in the presence of family and hospital staff, that she didn't want a DNR order, that she wanted to go home, that she wanted to see her grandchildren graduate school, that she wanted to meet my fiancee, etc etc.

Question: Can legal action be taken against my sister for the wrongful death of my mother based on the statements made by my mother while in the hospital, either civil or criminal?

Hopefully one of the lawyers will clarify, but it is my understanding that as the Legal Healthcare Proxy (or durable power of attorney or whatever it is called in each state) has been designated by the patient to make healthcare decisions if the pt is unable to. That means that your sister had the LEGAL right to sign a DNR on your mother.

Now I do not know if you can challenge your sister's decision in a court, due to her having the LHP. I do know that your mother was VERY sick, as evidenced by her quick passing after withdrawl intervening care. I am sorry for your loss, but it would appear that your mother would NOT have come home anyway...

Have you asked your sister WHY she made this decision? Perhaps your mother made new wishes known to your sister that you have not found out yet....

[Peetie]

Thanks for responding.

My sister signed the DNR order without my mother's knowledge or consent. My mother was lucid up until the treatment went from active to passive. Naturally, she had periods of sleep due to the morphine, but when she was awake, she was completely lucid, able to recognize people, able to carry on conversations, able to remember events, etc.

Yes, the Health Care Proxy gave my sister the power to make the medical decsions but ONLY if my mother was unable to. My mother made her wishes known repeatedly to the hospital staff and family members - she wanted to go home.

[ellencee]

Peetie
More likely than not, the physician spoke with your sister and explained that your mother's condition was leading towards death and explained that your mother had no chance of recovery.

As panzertanker stated, the fact that your mother died within 24 hours indicates her death was imminent and unavoidable.

Your family does not need this type of extra grief. Be supportive of one another.

EC

[Peetie]

Thank you for responding, EC.

I fully understand what you said but I still think that the switch from active to passive care is what caused her death to come so quickly.

She had been in that hospital for two weeks with the same condition. The doctors were telling us she could go today, next week, next month, etc - they simply couldn't say when. We all understood that, as well as my Mom.

We were trying to get her home, as her wish was, even if only to die there, and as I said, she showed periods of strength and lucidity. The nurses were telling me that she was doing well with the lasix and the down periods were normal, considering she was recovering from surgery, wasn't eating much and was getting morphine for the pain.

So, I'm still concerned and suspicious that the switch from active care to passive care is what caused the quick death.

Had Hospice intervened and gotten her home, where the lasix and oxygen would have been continued, she may have lasted longer than she did. Perhaps not, as we knew, but possibly.

What I'm afraid of is that the switch from active to passive care, brought about by the signing of the DNR order, is what caused the death coming so quickly. Had the lasix been continued . . . . . ?

[panzertanker]

Originally Posted by Peetie

We were trying to get her home, as her wish was, even if only to die there, and as I said, she showed periods of strength and lucidity. The nurses were telling me that she was doing well with the lasix and the down periods were normal, considering she was recovering from surgery, wasn't eating much and was getting morphine for the pain.

So, I'm still concerned and suspicious that the switch from active care to passive care is what caused the quick death.

Had Hospice intervened and gotten her home, where the lasix and oxygen would have been continued, she may have lasted longer than she did. Perhaps not, as we knew, but possibly.

What I'm afraid of is that the switch from active to passive care, brought about by the signing of the DNR order, is what caused the death coming so quickly. Had the lasix been continued . . . . . ?

Had she stayed on the lasix, it would have artificially prolonged her life for a period of time. How long? No one knows.
Unfortunately, as difficult as this situation is for you, there is nothing you can do about it now. Your mother is gone, and you must start to heal. I would focus on that rather than a finger pointing fight regarding whose possibly at fault for her passing away more quickly than expected. The docs told you she was just hanging on. I never make a guestimate as to how long a person has left. I learned a lesson a long time ago when I told a family that their sweet, sick GM had about 24 hours. She lasted 4 more days. The trauma of expecting a loved one to pass and having the "assumed timeframe" pass by is tortuous. That is why you were told days/weeks/months. However, you were told it was terminal. That means she WAS going to die. Lying in a hospital bed, being kept from your death artificially, can be more cruel than allowing God's plan and nature take it's course...

[BlondiePB]

Peetie,
I am sorry for the loss of your mother, too. I do understand the laws governing Health Care Proxy's and do have to make such decisions. After reading your posts and the replies from panzertanker and ellencee, I concur with them and the fact that your mother was imminent.

Even if resucitation efforts were provided, I do not believe the outcome would have been different. This comes from first hand experience with such efforts to resucitate a person in similar situation as your mother. Your mother would want you to come to terms with her death and pull together as a family rather than fight and resent each other over this.

[ellencee]

Peetie
Your mother wasn't going home, not with hospice, not with Lasix. She couldn't. I'm sure she wanted to go home and I'm sure you wanted her to come home one more time but it wasn't going to happen.

I am so sorry for your loss, not just the loss of your mother but for the loss of having your mother at home one more time.

Lasix is not an easy drug; it's hard on the body and after a while, it stops working effectively. CHF isn't easy on the body. Oxygen does little more than provide comfort. If withholding Lasix brought about your mother's death in 24 hours, death was 24 hours away with or without Lasix. DNR simply prevented the nurses from performing CPR, intubating, and administering some very powerful medications to your mother. Your mother did not need to have to go through that ordeal; the outcome would not have changed.

I am touched by your grief and by the compassion you are willing to show family members. Please remember that your sister had to make a decision that none of us ever wants to have to make and she has to live with making that decision. I'm sure your sister could use your sincere recognition of the difficult decision that she had to make.

EC