Penalty for violating a DNR order?

My great uncle Charles, not being in the best shape of anyone on the planet, has (had?) a DNR order; if he suffered a heart attack or something similar, orders were to let him die in peace, rather than try to resuscitate him. As far as I know, the medical staff in charge where he was knew about this.

They violated the DNR order. Any idea what we do about this? As far as I know, money isn’t really the reason for it so much as he’s rather old and living by himself, so if he were to suffer a debilitating stroke there wouldn’t really be much in the way of someone to care for him (his wife passed on a few years ago). He just didn’t want extraordinary measures taken to keep him alive if something were to happen. Evidently, such measures were taken, though I don’t know specifically what, only that the DNR order was not followed/violated/whatever the proper terminology is.

And if we could keep this away from “is it ever ethical to violate a DNR order?”, I’d greatly appreciate it. I put this in GQ for the reason that I’m hoping for a factual answer:)

You can sue for pain and anguish.

You can report the incident to your state’s/province’s medical governing body.

I doubt that there are any legal sanctions you can call upon. The actions resulted in prolonged life, rather than death and we don’t have any laws against life support. A prosecutor would be pretty reluctanat to take on a such a case. The medical staff can claim

  1. that they did not have the correct paperwork to exonerate them for taking no action,
  2. that the specific condition was not covered under the DNR order,
  3. that that the DNR was misplaced and that shift had not got the word (which is likely the actual reason). (I believe that if some clueless member of the staff begins taking measures, they are required to continue them, despite a DNR–this is a vague memory, not a medical or legal opinion.)

In any of those cases, the prosecutor would have a hard time proving negligence even if there is a statute to cover the event.

(You might also want to check on the explicit language in the DNR. Some DNRs allow for no action if it will result in the patient going on a ventilator, but still require/allow immediate CPR to see if the patient can get past a single incident. )

Living wills or DNR orders have to include a clause that states under what circumstances it is in effect. Most standard-language ones I have seen require that a person be deteremined by two physicians to have a terminal condition before and that the signer not be competent to make judgments on his own behalf before going into effect.

DNR orders that are always in effect can be obtained, but both the physician or lawyer advising the inidividual and the individual requesting the DNR order must explicitly specify this.

If a properly completed DNR order, applicable under the given circumstances, and which the medical staff knew about or should have known about, was ignored, it is legally the same thing as doing an invasive procedure without consent. At least in theory, both criminal charges (assault and battery) and civil action can be pursued. In practice, criminal charges are very rarely filed, but if a person’s worst fear were becoming a vegetable, or more correctly existing in a persistent vegetative state, and that happened due to resuscitative measures while a DNR order was in effect, a lawsuit could very definitely be brought against the persons responsible.

IANAL and this only applies in Texas.

A DNR does not apply to ambulance calls. EMT’s are required to provide reasonable care whenever they are on a call. Therefore, if your grandfather had a heart attack and an ambulance was called, the EMT’s are required to perform the level of care necessary to respond to the emergency.

Once you get to the hospital, the staff is required to perform the same level of care until the doctor writes an official order in the patient’s chart dictating the DNR. You can have a perfectly legal DNR sitting in your drawer at home and it doesn’t mean a thing. Your family and personal physician should have copies but make sure that the attending physician is made aware of the DNR so he can write the official orders.

If your grandfather was in a nursing home with a DNR on file, then maybe you have an issue unless standard practice is to call an ambulance in case of medical emergency (see paragraph above).

Sorry to hear about the problems your grandfather is having.

Sorry, I meant great uncle instead of grandfather. I was thinking of my grandfather while typing.