Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
50 min
2 speakers
4 chapters
transcribed 10 hours ago
Transcript
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What is the main topic discussed in this episode?
This podcast is CME eligible. To learn more about CME, Alex, what do they do?
They can either go to the CME tab associated with this episode, or they can go to jerrypal.org backslash CME.
And on to the show. Welcome to the JerryPell Podcast. This is Eric Wadera. This is Alex Smith. And Alex, we're going to be talking about unilateral DNRs. We did a podcast on slow codes not too long ago. We'll have links to that on our show notes. One of our guests was on that podcast, Alex, who are our whole guests today?
Yes. We're delighted to welcome back from that podcast Gina Piscatello, who is a palliative care doc, an ethicist, and a researcher at the University of Pittsburgh. Gina, welcome back to the JerryPal podcast.
Thanks for having me.
And we're delighted to welcome Aaron Di Martino, a pulmonary critical care doc, ethicist, researcher at the Mayo Clinic in Rochester, Minnesota, where the current temperature is.
Negative five?
Negative five, but it was negative four the negative twenty four this weekend, she's saying. You're
gonna go out with a t shirt today, it's warmed up.
No. Not that warm.
And we're delighted to welcome Will Parker, who is an intensivist, ethicist, and researcher at the University of Chicago. Will, welcome to the Jerry Pell podcast. Happy to be here.
So uh we got a lot to talk about unilateral DNRs and something I've never heard of before, unilateral DNR orders. But before we jump into that subject, we always have a song request. Gina, do you have the song?
I do. It is Heartbreaker by Pat Benatar.
Why did he choose Heartbreaker?
The reason is that oftentimes when new lateral DNRs are done, it's because doctors and nurses they don't want to break the patient's heart. So therefore heartbreaker.
That's a good one. All right, this is a fun one. Good energy. Here we go.
Your love is like a tidal wave. Spinning over my head. Drowned me and your promises, better left unsaid. You're the right kind of sinner to release my inner fantasy. The invincible winner, and you know that you were born to be. You're a heartbreaker, dream maker, lovetaker, don't you mess around with me, you're a heartbreaker. Dreammaker, love taker, don't you mess around
That was a fun one. Thank you, Gina.
Okay, Gene, I'm gonna start off with you. We're talking about unilateral DNRs. Can you tell me what a unilateral DNR is?
So these are DNRs that the doctor decides to not perform CPR on the patient. So it does not depend on the patient or surrogate consent to the DNR order. It is physician generated. Now the patient and surrogate, they might consent to it, but it's not necessary for the unilateral DNR order to be pursued.
So it's not during a code a doctor decides not to do the code. It's prior to the code. It's I'm gonna put in a DNR order that the patient has not consented or the family has not consented. Is that right?
Yes, ideally before. Yes.
Yeah. But yeah, Eric, um you know, to jump in, your your comment about during a code is an interesting one, right? Because we end resuscitation after usually 20 or 30 minutes and say CPR is not going to be successful. And we unilaterally decide to stop doing CPR at some point. That is an entirely clinician-initiated decision. And now with advances in technology, technology like VA ECMO, there ultimately is always a subjective judgment that a clinician is making about whether to provide CPR or other resuscitated measures. Whether you've attempted it initially or not. There's still a unilateral nature that's unavoidable now.
Yeah. And how long you keep going? Do you do several rounds or do you do fifteen rounds and at what point you may consider you know extra corporeal support?
You know, I encourage all our listeners to watch the Rethinking Slow Codes podcast. We talk a lot about all this, but like in the healthcare system I work at, we can't do unilateral DNRs at all. But So somebody has to be full code. But if they arrest, a physician does not have to and a code team does not have to code somebody if they think it is non beneficial. So it at least in our healthcare system, they're separating unilateral DNRs, which is
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Chapters
4 chapters
1
What is the main topic discussed in this episode?
0:00–11:58
2
What is a unilateral DNR and how does it differ from a traditional DNR?
11:58–24:04
3
Why do some clinicians choose to place unilateral DNR orders without patient or surrogate consent?
24:04–43:56
4
What does the research show about racial and language disparities in unilateral DNR orders?
43:56–50:22
Speakers
2 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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