A 68 year old woman was admitted to the hospital after coughing up blood. Her health has been declining in recent years and she made it clear on admittance that while should would accept treatment, she does not want any surgery to keep her alive, and asked for DNR and DNI orders.
The care team decided to do an upper GI scope. They found some abrasions on her esophagus that was causing minor bleeding. Believing that a larger problem may be further down, they went all the way to her small intestine. Unfortunately, the scope perforated her intestine, causing more bleeding. The esophagus problem could probably be treated without surgery, but the intestine problem requires surgery. The woman is now falling in and out of consciousness, and is no longer competent. Should the team do the surgery to fix the intestine?
The pt has filed a DNR and has an oral request not to have surgery to save her life. She does however want treatment for her condition. The surgeons caused a new condition that needs attention thus requiring the surgery for her treatment. The surgeons should perform the surgery to correct the perforated intestine while treating the esophageal bleed with non-surgical methods per her request. The DNR and DNI are not valid for withholding the corrective surgery.
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