Under Assault

They're heeerrrrreee! We've been waiting for months and they finally showed up. JCHACO has finally decided to grace us with their presence. They're the lovely people who accredit our hospital. Without their approval, we're out of business, so it is fair to say that we do kow tow to them and try out best to please them. What choice do we have? But what happens when the surveyor is an idiot? What then?

The idiot told us that whenever a patient is a DNR (do not resuscitate) the matter must first be referred to the bioethics committee. Excuse me? The patient in question was elderly, alert and oriented and wanted to be a DNR. Her family was in agreement. So why would we refer a situation like this to the bioethics committee? The committee is involved when there is a dispute with the patient, family members or staff about the proper course of treatment. There were no issues here.

We have six DNRs on the floor right now. That's nearly half of our patient census. It is a high number, but that is what the patients and their families want. None of them were referred to the bioethics committee because there is no dispute over what anyone one's wishes are.

I hope that administration doesn't cave on this and add to our protocol that all DNRs must first be approved by the bioethics committee. That requirement would just result in unnecessary suffering by requiring us to keep alive, by whatever means necessary, people who just want nature to take its course, that is until the committee could meet.

I'm wondering if the surveyor in question is truly an idiot who doesn't know what bioethic committees do or if he is of the belief that DNRs are murder. Some people believe that and if he feels that way, perhaps he's trying to impose his personal beliefs on us. Or, does he think that since there are so many DNRs, we must be forcing them on people to save us money? We are a big HMO, but even we wouldn't resort to that.

It would never be allowed, but I wish that I could question him to determine if he's

1) an idiot,

2) a misguided moral zealot, or

3) if he thinks that we are trying to talk people into refusing resuscitation to save money.

What do you think?