Human Exceptionalism

Negligence is not Futile Care Theory

I have had some buzz today that a new futile care case may have come to the fore after an Illinois nursing home, the North Logan Healthcare Center in Danville, was fined for violating a patient’s advance directive declaring that he wanted to be resuscitated. But as I looked at the case based on the investigation records posted by the Illinois Department of Health and Human Services, this seems more a mistake than an intentional and deliberate violation of the patient’s desire for life-sustaining treatment. From the records:

Based on interview and record review, the facility failed to [1] Implement Emergency Procedures as required by facility policy and [2] Honor an Advanced Directive request to be resuscitated for 1 of 19 sampled residents (R7).

And indeed, that certainly seems to be what happened. But rather than Futile Care Theory, this seem to be a matter of negligence and not following proper procedures:

When interviewed again at 2:40 p.m.on 5/24/07, E7 stated, “I had had that in the back of my mind that he (R7) was a full code. I took a radial and carotid pulse when staff found (R7) and there was none.” “(R7) had been improving the past few days prior to this. I did not take vitals when(R7) was not responsive earlier. The CNA probably thought I was surprised (when I was checking the chart) because I said, ‘Oh my god, he is still a full code.’ I really thought he was a DNR (Do Not Resuscitate) at that point….I did not pull the chart and take it with me when I went to the (R7’s) room.” “Staff had talked to (Z3, POA), about making (R7) a DNR. I thought the process was completed…

This was wrong. But it was not the imposition of a bioethical theory upon a helpless patient.