Understanding Do Not Resuscitate Orders - Assignment Example

Not for Resuscitation Orders [Name of the Student] [Name of the University] Not for Resuscitation Orders Do not resuscitate (DNR) orders provide an opportunity to the competent patients to determine the circumstances under which they choose to live (Legal, Ethical, and Safety Issues). Medical ethics are founded on the principles of justice, beneficence, non-malfeasance and patient autonomy (Swaminatha , Gus, & Garmel, 2005, p. 653). Autonomy is the freedom of an individual to choose his own path, as long as it does not interfere with the liberty of others. It is essential to treat patients as autonomous persons; hence, they possess the right to undergo various procedures and treatments, and this includes life – sustaining medical care (Pat, Suen, & Ying, 2009). In addition, the beneficence theory connotes that one should always do good, and requires a moral agent to encourage the welfare of others. This theory requires the incompetents to be provided with treatment that ensures their best interests (Bodenheimer, Bodenheimer, & Grumbach, 2008, p. 147). Cardio pulmonary resuscitation (CPR) is employed in emergency conditions, and requires the physician to consider several ethical issues. Some of these are, determining whether CPR is necessary, and concerns regarding the withholding or withdrawing interventions. A few other issues are advance directives, presence of family members, provision of palliative care to the patient, and the maintenance of communication with family members of the patient (Marco, 2005). Bioethics proves invaluable in addressing these issues. In instances, where curative care is futile or undesirable, the focus of terminal medical care should be to provide comfort to the patient and family, instead of employing technological interventions that cannot improve the condition of the patient (Marco, 2005). Futile cardio pulmonary resuscitation (CPR) has been employed by ambulance professionals to patients with cardiac arrest. This is in order to benefit significant others or professionals (Bremer & Sandman, 2011, p. 495). With regard to patients who do not stand to gain by futile CPR, it has been provided in the guidelines that this intervention is not to be applied (Bremer & Sandman, 2011, p. 496). As such, ambulance professionals are to employ futile CPR, only after assessing various criteria, such as, place of cardiac arrest, initial rhythm, age of the patient and return of spontaneous blood circulation prior to transport and shock being provided at the site (Bremer & Sandman, 2011, p. 496). This approach enables the ambulance professionals to assess whether CPR would be futile from the physiological perspective of the patient. Under these circumstances, the patient does not obtain any tangible benefit from continued CPR. Even if the patient survives, due to the CPR, there is every possibility of the onset of harmful effects, such as severe brain damage that would lead to a drastically reduced quality of life. Nevertheless, CPR is continued in such situations, because of the explicit desire of significant others to do so, in the hope that the patient would survive the cardiac arrest. Another reason for such continuance is that the significant others may not be emotionally ready to accept the demise of the patient or when they find field termination unpalatable (Bremer & Sandman, 2011, p. 496). This situation is intricate, as there is an established norm that futile treatment should not be provided to patients. In this context, it is difficult to determine what constitutes futile treatment and another question that arises is whether some forms of futile treatment are warranted from the ethical point of view. Two important concepts come into play in this situation; namely, physiological and qualitative futility. The former addresses the issue of whether the treatment had resulted in some explicit medical result. On the other hand, qualitative futility balances the associated risks and values. In this context, physiological futility implies that the administration of the CPR will terminate the patient’s life (Bremer & Sandman, 2011, p. 496). A much higher standard of care is required of individuals who are duty bound to respond to people in need of assistance. As such, persons who declare the possession of a skill have to discharge their duty to a standard that can be expected of any other competent person with similar training and experience (Adult advanced life support: Australian Resuscitation Council Guidelines 2006, 2006, p. 353). The notion of informed consent enables individuals to approve of events that are expected to transpire, regarding their person. In the field of medicine, informed consent is acquired with respect to participation in research and treatment. Nevertheless, it is not possible to always obtain informed consent, especially if the patient’s clinical condition is very critical. During a medical emergency, the absence of informed consent does not prevent the provision of treatment. Moreover, in the area of emergency research participation, several other ethical factors come to the fore, if informed consent is not obtained (Biros, 2007, p. 361). Patient autonomy plays an important role in the present day medical services. Accordingly, patients should be informed about the advantages and disadvantages inherent in any treatment provided to them. There has been a considerable change from the past, where the moral diktat was invariably to choose life. At present, the dilemma is related to the circumstances under which life is to be selected. This state of affairs is quite complicated, and it is up to the professionals and the public to determine the line dividing what can be done from what should be done. In addition, considerable moral courage is necessary, in order to promote the fundamental values associated with compassionate end of life decisions. It is the duty of the nurse to utilise ethical principles, such as autonomy, fidelity and veracity, while taking up this delicate issue. Nurses are greatly assisted by moral courage, when they have to confidently and steadily envisage the ethical dilemmas surrounding DNR discussions (Lachman, 2010, p. 249). It has generally been observed that nurses proved to be quite competent while initiating discussions relating to DNR. They did not experience any difficulty in discussing DNR decisions with patients or their surrogates. Their undeniable expertise was unaffected by their qualifications, nationality, religious beliefs or professional training. There has been a long – standing relationship between the primary care physician and a patient. This association has bestowed several ethical protections to the patient, such as confidentiality, patient autonomy and inclusion of patients or their family relatives in the decision making process. However, there are certain hospitalist models that promote the deliberate discontinuity of care (Wachter, Goldman, & Hollander, 2005, p. 127). These models raise ethical concerns, in addition to jeopardising these protections. Neurological critical care was accompanied by several ethical issues. As a result, brain death was deemed to be death from the medico – legal perspective. This situation raised a number of ethical questions (Kuhse & Singer, 2006, p. 347).In cases of permanent vegetative condition, providing merciful death is recommended by the principle of non-maleficence. Many scholars have opined that it would not be in the best interests of individuals in a permanent vegetative state if they were to be provided with life – sustaining treatment. Thus, there were several instances, wherein resuscitation merely prolonged the dying process, without any tangible medical benefit. This makes a strong argument for preventing unnecessary suffering, by allowing such persons to breathe their last. The decision to abstain from providing resuscitation could be deemed to be morally correct, as the patient is permitted to die with dignity and peace (Pat, Suen, & Ying, 2009). A moral agent is precluded by the principle of non – maleficence from causing harm to others (Field). In addition, every individual shoulders the responsibility of protecting others from harm. Consequently, providing treatment to a patient, when this is futile constitutes an assault on that person. This makes it morally wrong to perform CPR when such intervention would result in harm to the patient. It should be borne in mind that CPR causes severe damage to the brain, heart or lungs. This would cause either death or irreversible coma, after a few hours or days (Pat, Suen, & Ying, 2009). As the principle of non – maleficence requires service providers to desist from harming the patient, during the application of futile treatment, service providers have to make the relevant decisions, on the basis of the circumstances obtaining. The extant practice of CPR fails to achieve the desired results. Present day health care consists of evidence based education or the theory and dynamic psycho – motor skills or practice. This combination is expected to provide high quality health care. Such expectations were not realised, due to the absence of ethics or concern regarding implementation of theory (Mortell, 2009, p. 151). This commendable situation does not hold good in practice, where a surrogate decision maker and the attending physician take matters into their hands and come to a decision. The reason behind this is that the patient no longer possesses the capacity to come to a decision (Lachman, 2010, p. 249). Moreover, the patient’s economic or social status should not have any bearing on the emergency medical service provided. Such medical service should be equitable and available to all. It is only the medical and operational concerns that should establish patient care priorities. List of References Adult advanced life support: Australian Resuscitation Council Guidelines 2006 . (2006). Emergency Medicine Australasia , 18 , 337 – 356 . Biros, M. H. (2007). Research without Consent: Exception from and Waiver of Informed Consent in Resuscitation Research. Science & Engineering Ethics, 13(3), 361 – 369. Bodenheimer, T., Bodenheimer, T. S., & Grumbach, K. (2008). Understanding health policy: a clinical approach. McGraw-Hill Prof Med/Tech. Bremer , A., & Sandman, L. (2011). Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis. Nursing Ethics, 18(4), 495 – 504. Field, R. (n.d.). A Practical Guide to Ethical Theory. Retrieved September 28, 2011, from http://catpages.nwmissouri.edu/m/rfield/nwcourses/274guide/274guide1.pdf Kuhse, H., & Singer , P. (2006). Bioethics: an anthology. Wiley-Blackwell. Lachman, V. (2010). Do-Not-Resuscitate Orders: Nurse's Role Requires Moral Courage. MEDSURG Nursing, 19(4), 249 – 252. Legal, Ethical, and Safety Issues. (n.d.). Retrieved September 28, 2011, from NIH Clinical Center: http://www.cc.nih.gov/participate/patientinfo/legal.shtml Lyons, R. (n.d.). An Ethical Infrastructure for a Happier World. Retrieved September 28, 2011, from http://www.dupontcastle.com/happinessethics/ Marco, C. A. (2005, January 15). Ethical issues of resuscitation: an American perspective . Retrieved September 26, 2011, from http://www.biology-online.org/articles/ethical_issues_resuscitation_american/ethical_issues_resuscitation_american.html Mortell , M. (2009). A resuscitation ‘‘dilemma’’ theory–practice–ethics. Is there a theory–practice–ethics gap? Journal of the Saudi Heart Association, 21, 149 – 152. Pat, W., Suen, L., & Ying, S. (2009, March 22). Ethical dilemma: do not resuscitate a vegetative paediatric patient. Retrieved September 28, 2011, from http://www.thefreelibrary.com/Ethical+dilemma%3A+do+not+resuscitate+a+vegetative+paediatric...-a0206790219 Swaminatha , V., Gus, M., & Garmel, M. (2005). An introduction to clinical emergency medicine. Cambridge University Press. Wachter, R. M., Goldman, L., & Hollander, H. (2005). Hospital medicine. Lippincott Williams & Wilkins. Read More