Medical Staff House Staff Orientation Manual - Montefiore Medical ...

• A patient, agent or other family/surrogate who requests that intubation be foregone in
light of the patient’s medical condition and known wishes.
• A capacitated patient, after discussion with the attending physician, may consent to
foregoing intubation or re-intubation for present or future moderate-to-severe respiratory
distress or under any future circumstance.
A DNI order may be written for an incapacitated patient who has been determined by the
attending and concurring attending physicians to lack capacity and for whom a DNI is medically
indicated, in the following circumstances:
• a health care agent for an incapacitated patient may consent to foregoing intubation or reintubation
for present or future moderate-to-severe respiratory distress or under any
future circumstance, or
• a family member or other surrogate who knows the patient’s wishes about intubation
may also consent to foregoing intubation or re-intubation for present or future moderate
to severe respiratory distress. The family/surrogate must have fully discussed the
patient’s prior declared treatment choices and best interests with the attending physician
and agreed to a DNI order.
WHEN:
• The patient’s condition and prognosis are so poor that intubation or re-intubation is likely to
merely prolong dying or increase suffering without providing substantial benefit and
• the capacitated patient chooses to forego intubation, or
• the incapacitated patient’s proxy chooses to forego intubation, or
• the surrogate/family provides evidence of the incapacitated patient’s prior wishes to forego
intubation.
WHERE:
• DNI orders to forego intubation may be appropriate in any clinical setting.
• Efforts will be made to communicate decisions to forego intubation/DNI orders to nonhospital
facilities and providers.
HOW:
Foregoing intubation in situations other than cardiopulmonary arrest requires consent by:
• A capacitated patient or a health care agent or other surrogate for an incapacitated patient
who has had a documented discussion with the attending physician about the patient’s
intubation wishes.
• The attending physician’s DNI Documentation form (OD1080-1) and the Patient’s
/Surrogate’s Consent to DNI form (OD1080-2) are available on all clinical units.
After completing the DNI documentation form, the attending must enter a written or
electronic DNI order.
CONTACT:
Office of the Medical Director 718- 920-7052, -2809, -6078
Palliative Care 718- 920-6378
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