Medical futility, DNI and DNR

Don’t expect very much input from me, but we used our time last friday to discuss the way we reach the conclusion that a stroke in an elderly patient perhaps should be treated not too aggressively. More clearly, how do we determine, whether the patient is going to die. 

This is a sensitive topic and it concerns our basic ethical, religious and moral experience. It requires some facts (but not many) and a lot of discussion, so this is, what we tried to do. I think, that the style of discussion coaching that Problem-based learning supplies, might be the best environment to reach such conclusions, and the discussion should be interdisciplinary, including physiotherapists, SLTs, nurses, doctors, relatives and so on. But in practice such ethical conferences are only scheduled if the core ethical problem is really hard (or hard to understand). Your straightforward 87yo big MCA stroke is somehow “easier” (please don’t understand this the wrong way) – also we could not call an ethics board for every DNI order.

My solution is to make the discussions more open, use rounds and pre/post-round-coffee-time to discuss DNI/DNR orders and other therapeutic limitations. And this requires some experience…

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