Physician Orders Nurse Not To Resuscitate: Court Faults Physician
Legal Eagle Eye Newsletter for the Nursing Profession
May 1998
Quick Summary: The loss of even a small chance of survival and rehabilitation is worth something and cannot be arbitrarily taken away, even if the chances of successful resuscitation and rehabilitation are questionable and the damages for the patient’s death in a civil lawsuit would be devalued due to her preexisting medical problems.
One of the nurses testified the doctor’s order not to resuscitate the patient was an act of mercy. That might well have been so, as even if the patient were revived her prospects for quality of life were not good.
Courts in other jurisdictions have compared this situation to a lottery. A lottery ticket represents the chance to win a contest. Even if the odds of winning the lottery are small, a single lottery ticket still has some value.
There is a national trend in favor of the courts awarding compensation in loss of chance of survival cases, even when the patient’s odds of surviving the condition which brought the patient in for treatment were less than fifty percent to start with.
SUPREME COURT OF IOWA, 1998. The patient had been in the hospital for two months for fibrotic lung disease and multiple myeloma. However, according to the court record, this was in remission and she was doing fairly well for someone suffering from chronic disease.The Supreme Court of Iowa pointed out that neither the patient nor a family member of the patient had requested a No Code order be placed in the patient’s chart. The patient had been resuscitated three times during her hospital stay and had never asked her doctor to place a No Code order in the chart. Shortly after one of these prior incidents, the patient’s husband explicitly told the doctor he wanted his wife placed on a respirator if that proved necessary to keep her alive.
The patient went into cardiorespiratory arrest at 4:40 a.m. One nurse got the crash cart, while another went to get her doctor who was close by. When the doctor arrived he checked her pulse, listened for a heartbeat, listened for respiratory effort and looked at the pupils. The doctor reportedly stated, "I just can’t do it to her," and ordered the nurses not to perform CPR or take any measures to revive the patient, and she died.
The nurses involved testified if they had not been so ordered by the physician, they would have called a full code, performed CPR and done everything within their means to resuscitate this patient.
The court ruled the physician’s judgment was faulty. The court ruled the family had the right to sue the physician, even though this patient had no practical chance of surviving her preexisting medical condition and faced the very real prospect of diminished quality-of-life even if she were revived. Even a small chance of survival should be compensated, the court ruled.
The court did not fault the nurses for following instructions from the physician to cease their efforts to resuscitate this patient.
Wendland v. Sparks, 574 N.W. 2d 327 (Iowa, 1998).