You notice the section you quoted says “physicians should assess the amount of information a patient is capable of receiving at a given time, delaying the remainder, more suitable time … to meet patients’ needs and expectations in light of their preferences.”
That’s the PATIENTS’ preferences, not the preferences of the family. The point is and always has been that the PATIENT is the one that gets to decide if they don’t want to hear what’s going on. Not the family.
Yes, I would.
If the nurse asked your wife then your wife was the one making decisions for her. If the nurse asked anyone other than YOUR MOTHER first then the nurse fucked up.
First off, if you have an unconscious patient, you can’t really ask them to make decisions. Someone has to make those choices for them. Close family is a logical choice.
Secondly, it’s perfectly normal for people OTHER THAN THE ONE IN QUESTION to know that person’s preferences and be able to relay that information to others. If Mommy Dearest has preciously indicated she doesn’t want to be resuscitated should the situation arise, and the daughter-in-law tells the nurse this information, she is most certainly NOT making decisions for MD. She is passing along information that she happens to be privy to.
According to Washoe she was sedated. It’s not that difficult to ask questions before you administer a sedative, or wait until it wears off.
Knowing someone’s preferences is fine. Nobody has a problem with the family knowing and providing that information - but only after the patient themselves has said it’s ok for them to do so.
If Washoe’s mother was coherent enough for him to think she would be frightened to hear about what happened then she is also coherent enough to decide on her own if she wants to know what happened.
I’ve never said that families should not be involved - just that they should not unilaterally make decisions on the patient’s behalf UNLESS THE PATIENT THEMSELVES SPECIFICALLY INDICATES THEY WANT THAT. Christ on a fucking cracker, how dense do you have to be to not get that?
Why don’t we try this:
Washoe, does your mother have written directives?
Washoe, has your mother discussed her wishes in regards to medical treatment with you in the past?
Because that’s the information that missing here. Jetgirl’s biggest concern is that Washoe’s Mom has been cut out of the decision loop involuntarily. However, if there are prior directives and input (such as the case with my mom) then that changes the whole situation quite a bit. Even when not written down, if a person has expressed a preference or viewpoint to the rest of the family that can carry considerable weight.
When someone is pulled into an ER the priority is on saving their life and stabilizing them, not on grilling them for information. Sedatives can have wildly varying effects and ill/injured people may be conscious but incoherent.
Asking if an elderly and very ill person has a DNR order is not inappropriate, no more so than asking if they have any advanced directives, religious prohibitions to blood transfusions, or any of a number of other questions. Some people do have DNR’s, some of those people are surprisingly healthy in appearance (my mom carried hers in her purse for years, walking around the grocery store and the mall with it, just in case she had a sudden collapse). If my mother is unconscious, delirious, or unable to communicate (my mother does have a form of aphasia) it is entirely appropriate for medical personnel to ask a family member that question because, aside from the patient, family is most likely to know.
The key here, to my mind (maybe not Jetgirl, I can’t speak for her) is whether or not any of the pertinent issues had ever been discussed with the mom before this hospitalization. Is this a woman who, for years, whenever someone she knew had a stroke said “Oh - I just couldn’t handle knowing! If it happens don’t tell me until I start getting better!”? Or is this truly a unilateral decision on the part of the family?
So it’s okay to know a person’s wishes, but not okay for you to tell others so that they can respect those wishes? :dubious:
For the most part, I can see where you’re coming from, but someone has to make those decisions and relay that information at least until the point that the patient is stabilized enough that they can be asked directly. Or in more detail, what Broomstick said. A DNR order is on the list of things that may be needed to be known before that point comes.
They may be incoherent but the doctors still have an ethical duty to inform the patient of what is happening to them.
And nobody has said even come close to insinuating that asking is inappropriate.
What’s inappropriate is asking the family before asking the patient themselves, not going straight to the source first.
Washoe has never said that his mother was not stable enough to communicate her wishes. If she were, would he really be that concerned about scaring her with the facts?
In a case where the patient cannot communicate their wishes, yes, it’s perfectly appropriate to go to the family. This is not that case. His mother is not in a coma, and she was out due to a sedative. They could have asked her directly but did not. The failure is in bypassing a patient that has the ability to communicate their own desires firsthand.
I wouldn’t want anyone who would do that to be in any way involved with my medical care because I would not be able to trust them on any level.
If my family ever did that, they could count on such a thing ending any relationship I have to them.
Which some overzealous dipshit could infer out of your desire to make a decision they disagree with, or to know something they want to withhold. I get that vibe from your phrasing here, that you would assume anyone who had a serious injury or illness is suddenly mentally incompetent and you can do what you want.
Should anyone’s doctor be talking to their family members unless the patient themselves have given explicit permission to do so?
Unless the patient has explicitly stated that they want the family to be consulted, why are their wishes even being considered?
This is why my family does not have power of attorney for me. Because I don’t want someone making decisions that they think are in my best interest. I want someone who is detached and objective who will carry out the decisions I have already made.
So that means if my mother lies to my doctor and says I want her making all the decisions, that’s what happens? Good thing I have that power of attorney, eh?
And it may be the completely wrong choice. The thing that scares me is not being in a situation where I’m severely injured. It’s not having a way to indicate that they need to ask the person who has power of attorney for me, not my mother, what to do.
My parents know that I don’t want them making those decisions. I told them, and I told them why, but I don’t know if they could stick to that should something happen. I don’t know that they would say ‘Here’s the phone number of her power of attorney.’ rather than start telling the doctors what they think should be done to/for me.
Unless, of course, that patient has set up a power of attorney that names someone else to make those decisions.
clap clap
Mr. Kitty went into the hospital twice last year, and ended up in the ICU both times. The first time, his O2 level was 48, CO2 was 120, I was sitting right there and they still asked him all those questions. They even handed him a copy of the advanced directives booklet to fill out (he had an AD, but wanted to make sure he hadn’t changed his mind about some things since his diagnosis). When he was intubated, he was sedated for much of the time because he kept trying to pull out the tubes; however, every doctor that came in talked to him before talking to me, and the only reason most of them talked to me was because he hadn’t gotten the writing thing down yet.
I can get behind medical folks asking questions of the family when the patient is sedated. But clearly by the time the pulmonologist came in to “mess everything up” she had been awake and alert for some time (enough that Washoe’s wife looked to her and saw a look of panic on her face when the diagnosis was revealed). Boy, I hope the mom likes the wife, because I can think of dozens of situations where the daughter-in-law being that involved in medical decisions could go horribly wrong.
Washoe, I’m sorry, but I think you have a really, really warped idea of how hospitals “should” work. “Nobody is supposed to discuss diagnosis with a patient without authorization.”?? You claim it’s because the PCP is supposed to hold all those conversations, but what if you’re in a hospital that your PCP doesn’t have privs at? What happens if something goes wrong and your PCP is on vacation, or not on call? I can see “No one else can diagnose the patient” (although that’s an issue in and of itself), but your mom had already been diagnosed long before this incident. Everyone around her (but her) knew she had a stroke. So based on basic medical ethics the pulmologist acted reasonably. We’ve come a long way from the days when people weren’t allowed to make their own decisions or be included in discussions about their condition and care. Honestly, it terrifies me that anyone could choose to LIE and keep me in the dark about the nature or severity of my condition, especially if I’m awake. Had I been in your mom’s shoes, the pulmonologist- the ONLY person who has been honest this whole time- would’ve skyrocketed to the top of my Christmas card list.
In addition to Broomstick’s questions, I also want to know: how was it documented that the diagnosis should be kept secret? Who was aware of this decision? Also, not my business or needing to be answered, but how are you going to address this with your mom and rebuild her trust in you?
Exactly. The concept in all of this is that the patient should be the first and foremost point of contact and source for decisions about their own healthcare and absolutely every possible effort should be made to ensure that the patient is aware of their condition and that their requests are being carried out.
Advanced directives and power of attorney are the means to carry out the patient’s wishes in the case they themselves cannot make their wishes known.
No one should ever just assume that anyone else has the authority to speak on behalf of the patient.