Author Topic: Who tells?  (Read 15172 times)

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Offline PrincessMuni

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Who tells?
« on: September 04, 2008, 10:15:09 AM »
Imagine the following situation:   You are assigned a 91-year-white female, admitted with urosepsis, requiring mechanical ventilation and intubation. Despite IV antibiotics, fevers jump through the roof along with climbing WBC counts and bands with a left shift. Within hours, Levophed is infusing at 60 cc/hr, NS is running wide-open, urine output stops flowing, and acrocyanosis arrives. Dopamine is added. Pitressin comes next. Soon you run out of electrical wall sockets as more inotropic drug support is added to sustain life.

The family hovers outside the door, without any sort of DNR discussion with the medical team. As the night wears on, the patient looks paler and paler, her cardiac rhythm now shows major ST depression leading way to a wide complex slow ventricular rhythm. By morning the patient's systolic blood pressure is near 54/?, and she's unresponsive as you provide oral care. Yet still the family "wants everything done." But there is nothing more to do. Palpable pulses barely exist. Mottling creeps along her limbs. There is no life.

The two residents seek to place a new arterial line instead of sitting down with the family to initiate a discussion about medical futility and comfort care. The nurse mumbles to the team, asking them to talk with the family about death and dying all night long, to no avail. The family continues to wonder in the hallway, hovering outside her room as her HR slowly begins to drop. They want dialysis now.

Still, no one talks to them about DNR options. No healthcare proxy exists. If you were in this situation, what would you have done?
Does a nurse have the right to tell a family about DNR options or should it remain a discussion with the physicians?   ??? ???

Would like to see nurses and doctors opinions about this situation.


Intelligence plus character- that is the goal of true education

Dr. Martin Luther King Jr.


Offline Yaxya

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Re: Who tells?
« Reply #1 on: September 05, 2008, 09:28:31 AM »
i think DNR is not allowed in Islam since it is part of mercy killing ....
u can see this link:
http://somalidoc.com/smf/index.php/topic,988.0.html
الأسوار التي تحيط بنا عالية، وعلى من لا يستطيع أن يهدمها أو يقذفها أو يتسلق عليها... عليه أن لا يزين للباقين الجلوس خلفها.

Offline PrincessMuni

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Re: Who tells?
« Reply #2 on: September 06, 2008, 12:14:23 AM »
Oh! i never knew that DNR is not allowed ?
ok then, your answer solved the problem :) thanks alot
How about another question...
Does nurses have the right to tell the patient or the patient's family about his condition? seriously ? coz i've seen in here that whenever a patient ask the nurse about his condition or even the family, they say: The doctor will come now??
Intelligence plus character- that is the goal of true education

Dr. Martin Luther King Jr.

Offline Ikram

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Re: Who tells?
« Reply #3 on: October 26, 2009, 06:19:50 PM »
his is a good question that bares thinking about,

From my professional experience where I have  found myself the middle person in the communication barrier. You always have to remember that you are the families advocate and it is your responsibility that the family/patient are treated with integrity and respect. I always try to be as honest as possible baring in mind that there some issues that you can not disclose, but that does not mean that you have to be misleading the family  about the assessment of your patient. I would encourage the doctors to sit down with the family to prepare them for the various outcomes. If this does not work, then you just have to be  assertive.

Ikram
The fragrance of flowers spreads only in the direction of the wind. But the goodness of a person spreads in all directions!

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Offline PrincessMuni

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Re: Who tells?
« Reply #4 on: January 25, 2011, 07:05:12 PM »
To Yahya,
u said DNR is not allowed in Islam... Yesterday there was a 1 7/12yr child with SMA .. parents asked for DNR
they were Muslim Indians and by 11pm child passed away.

so.. is DNR allowed?
Intelligence plus character- that is the goal of true education

Dr. Martin Luther King Jr.

Offline Yaxya

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Re: Who tells?
« Reply #5 on: January 26, 2011, 08:34:54 AM »
@ princess_muni : it's really a controversial issue in the west specially from the ethical point of view,but in the Muslim world  i think our scholars have already discussed about it and according to them it's HARAM.. No matter whether some Muslims practice it or not ..and by the way welcome back:)
الأسوار التي تحيط بنا عالية، وعلى من لا يستطيع أن يهدمها أو يقذفها أو يتسلق عليها... عليه أن لا يزين للباقين الجلوس خلفها.

Offline PrincessMuni

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Re: Who tells?
« Reply #6 on: February 09, 2011, 09:06:40 AM »
thanks bro !
Intelligence plus character- that is the goal of true education

Dr. Martin Luther King Jr.

Offline Ikram

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Re: Who tells?
« Reply #7 on: March 04, 2011, 08:05:18 AM »

 You have the opposite problem princess muni where your patient are not offered DNR. Imagine when you are offered it and as a muslim you refuse it ....horrible enough ....you are then seen as a cruel person who are selfish enough to make your patient suffer longer.

  From my practical experience I have noticed that regardless of the conditions ....most muslims refuse DNR and it pains them to see their family member suffer like that and when the medical staff adds to the pressure by looking down on them as being selfish people who are evil ...is heartbreaking to see .

Funny enough this happens only once the DNR has been offered ...so not being offered it a good thing.
The fragrance of flowers spreads only in the direction of the wind. But the goodness of a person spreads in all directions!

                     Smiling!

Offline Mona

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Re: Who tells?
« Reply #8 on: March 04, 2011, 10:11:47 PM »
salaam everyone,

I, like princessmuni, was surprised when reading the above post by brother yaxya. I didn't think DNR was haram :S
I only thought that certain conditions should be fulfilled to allow it.

http://www.islam-qa.com/en/ref/115104



 

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