❗ A show code, even with patient/family consent, undermines patient autonomy, patient-physician relationships, and professional integrity. DNR DNI ➡️
"Do everything." Ms Smith's family members have been saying this from the start of her latest hospital admission, which started 3 weeks ago after a myocardial infarction. Two years ago, a stroke left Ms Smith, age 89 years, with left-sided hemiplegia but no cognitive impairment. She also has type 2 diabetes and hypertension. Her oldest child, Jean Carey, has been at the hospital every day.
Internist Frances Belmont has been caring for Ms Smith for many years, although she had not had much interaction with her children except for meeting Ms Carey at her mother's last office visit. On Ms Smith's admission to the coronary care unit with renal, respiratory, and heart failure, Ms Carey called Dr Belmont trying to get more information.
Having lost their father and favorite aunt in the past 6 months, Ms Smith's 3 children are, understandably, distraught. The doctors have been discussing their mom's condition and prognosis at length and have now broached the topic of a do-not-resuscitate order for Ms Smith, but the family members are very opposed and want"everything possible" to be done. Ms Carey has left a message for Dr Belmont asking for advice.
Dr Belmont thinks a DNR order is appropriate and is contemplating how events might unfold without a DNR order. She fears that the treatment team may resort to a"show" code for the family. She is concerned for the family but feels strongly the primary obligation is to the patient.
How should Dr Belmont discuss the DNR order and its implications with Ms Smith's daughter when she calls her back?
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