From the MD perspective..You have a relationship with a patient. You have explored the wishes of a patient with regard to ordinary and extra ordinary care.
On the other end of things is reality. The population of nurses is getting older. The number of nurses that know intrinsically and morally that DNR is not equal to no care is diminishing daily.
It has been 30 plus years since Rowe/v Wade. The nurses replacing the old timers have been acculturated into some lives being expendable.
When I was in nursing supervision, I had to snatch a few young nurses aside for little talks. One in particular announced when walking into the unit..”What is this DNR doing in my unit, get them out of here”.
The problem is not the orders...The problem is the attitude.
I have seen it more times than I can count...Early signs of CHF are ignored, unless you have a family member out at the desk being a squeaky wheel, the doctor doesn't get called.
SVT gets ignored. Someone gets a dose of pain meds instead of calling the doctor when there is chest pain.
I agree that the concept of “No care” is a grave error but the battle over attitude has already been lost.
I testified in front of a State Legislature commission a number of years ago on elder issues. The whole day was filled with back to back stories of elder neglect in hospitals and the DNR issue came up over and over.
It's the law of unintended consequences and it has had and will continue to have an impact.
That being said...I've worked with many bed-side healthcare professionals that wouldn't know a patient in distress...if their life depended on it. But this didn't have anything to do with the patients code status. More to lack of education and/or mentoring after formal education. And frankly probably laziness too...
ALL that said.....I always advocate a family member or a friend to be with ANY patient in ANY hospital. I don't care if it's the Mayo Clinic, or Loma Linda University Hospital, or any fairly well respected facility.
There are idiot doctors, idiot allied health workers, and idiot nurses everywhere..........