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DNR Refusal

Published on January 19th, 2020

I saw an interesting story that raises moral, ethical, and legal issues related to dying with dignity and chocie.  What do you think?

On April 5, 2018, Andy Jurtschenko went into surgery at Newark Beth Israel Medical Center in New Jersey.  He needed a new heart but instead Andy suffered extensive brain damage due to a lack of oxygen during the heart procedure.

As one of the top 20 programs statistically across the nation, Jurtschenko felt safe in Newark Beth Israel’s hands especially Dr. Mark Zucker, and the main surgeon, Dr. Margarita Camacho. The program is nationally known for maintaining a high success rate while taking on the sicker and riskier patients, operating on older, overweight, and those who have had regular visits to the intensive care unit because of their hearts.

For a single heart transplant, a hospital usually bills insurers around $1.4 million, and the better survival rates look to the public, the more patients that will choose to receive treatment at the facility. This business mindset forces transplant teams to look at patients not as humans, but as “percentages” and “numbers”.

A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating.  A DNR order is created, or set up, before an emergency occurs. A DNR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition. The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient’s family. Families order DNRs for multiple reasons. Sometimes a DNR is the obvious choice. It would preserve a patient’s dignity and reduce the amount of suffering the patient and the family will have to endure throughout the process.

Before a heart transplant surgery, a patient is not able to have a DNR in their file because the new heart may require stimulation to begin to pump, but after surgery, a patient or surrogate can ask for a DNR at any time and it must be sign by the physician and placed in their medical record.  It is a numbers game rather than a moral dilemma.  So when the Jurtschenko family requested a DNR for Andy, the doctors refused to sign.  On the morning of Oct. 31, 2018, Andy Jurtschenko passed away from a weakened heart after a long six month unnecessary battle between his value as a statistic and his doctors in the Newark Beth Israel’s hospital over his request for a DNR.

In the case of Andy Jurtschenko, a DNR could have reduced the suffering he and his family experience, but because his death would lower the program’s one-year survival rate, it could be assumed that doctors convinced the family that he would make a full recovery in the future.  It was not until Andy Jurtschenko was admitted into a nursing home where they caught the mistake that he was not supposed to be resuscitated, meaning the hospital never placed the DNR request in his record.

 

 

 

 

 

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