Ms. Miceli observes that Louisiana has no legal process like the 1999 Texas Advance Directives Act that offers safe harbor legal immunity. Indeed, she notes there is "no legal guidance" in Louisiana. (But the 1998 Causey case might suggest some caution.)
"So, what should an attending physician do when, in his or her professional judgment, any clinical treatment other than comfort care will be ineffective or harmful to a patient, but the family’s wishes . . . are in support of doing everything?"
Ms. Miceli advises that "a physician can act to validate his or her opinion on the appropriateness of the DNR order by obtaining the opinion of another physician, and . . . the latter’s signature on the DNR order as well as on an explanatory progress note . . . ."
"This 2-physician signoff process will serve to confirm the medical decision-making . . . and help protect the attending physician from claims of unsoundness or arbitrariness of decision. This 2-physician signature . . . is a prudent layer of protection . . . ."
This process does not provide what many providers crave in these situations: the elimination of uncertainty and risk. But Miceli is right. The fairer the internal process, the more likely it will receive deference and respect by external reviewers like a judge or jury.