Do Not Resuscitate or Right to Die - Report Example

Running Head DO NOT RESUSCITATE, RIGHT TO DIE Do Not Resuscitate This paper elaborates on the highly controversial issue of Do Not Resuscitate or the Right to Die. It explains the various technicalities involved in the DNR order and also throws light on the widespread discourse regarding the issue. It discusses both the pros and cons of DNR and attempts to validate each of these arguments. Do Not Resuscitate Introduction The Do Not Resuscitate order or the DNR, coupled with the contentious issue of euthanasia, has formed the focus of an ongoing controversy within the healthcare field. The Do Not Resuscitate protocol is essentially an order given by the concerned physician and duly signed by the either the patient or a surrogate relative. This order clearly states that no attempt should be made to revive the patient’s life in case of a cardiac or respiratory arrest. This rather extreme method is usually adopted by terminally ill patients, who have been enduring enormous suffering and thus, want to die a peaceful death. There is a common misconception that a DNR order implies that no medical services will be granted to the patient whatsoever. That is not the case. All efforts are made to relieve the patient of any pain, but if and when a cardiac or respiratory arrest occurs, no resuscitation attempts are made (American Medical Association, 2005). Several legal, ethical and religious aspects are intimately related to DNR. These sensitive aspects have made the issue of DNR potentially inflammable. The widespread discourse regarding DNR ultimately boils down to this unanswerable question- Do human beings have the right to end their own life? The fact that the DNR order has a somewhat obscure definition only adds to the controversy surrounding it. Even the best of physicians cannot deny the possibility of a natural revival, no matter how miniscule the chances may be. In that scenario, a DNR would amount to culpable homicide. Also, in many cases the patient himself is not in a conscious state to sign the order, which again reduces the credibility of the order. Owing to these uncertainties, people involved in the healthcare field have expressed a slight reluctance to carry out these orders. The DNR orders are carried out only if the close family of the patient insists strongly. (Murphy & Price, March 2007, P17-20). Pros The healthcare industry in the United States of America has been suffering from severe financial stress. The average life expectancy rose to nearly 77.8 years in 2005 (CDC, 2005). The country is, thus, faced with a large ageing population, escalating healthcare costs and millions of medically uninsured citizens. Ageing is inadvertently accompanied by biological deterioration of the general functioning of the body. As the ageing population increases, the number of people requiring intensive medical care would also increase. This, in turn would put further financial strain on the healthcare industry. A majority of the terminally ill patients, who do receive state of art medical care, do not survive ultimately. As ruthless and inhumane it may sound, it is always better to provide medical services to a person who has a better chance of survival. Therefore, if one looks at the issue purely economically, DNR or “Right to Die” will sound like the ideal choice. The patients (or their families) who sign the DNR order have little or no existence without the life support machines. In most of the cases, the patients are either terminally ill or already brain dead, which implies that their physiological systems are functioning through the various machines they are connected to. Their natural body mechanisms have all collapsed. They can remain in this state for months or even years together, with little chances of revival. This situation can be a huge burden for the patient’s family, both financially and emotionally. Not everybody can afford the life support systems, and even if the patient is covered by medical insurance, it can still be non-viable financially. DNR is also viewed by many as a compassionate means to cease the massive pain and suffering these terminally ill patients have to endure. Life, for them, is a traumatic experience and they prefer not to undergo any more invasive procedures or electric shocks. For these people, death is less painful than life. Thus one might argue that DNR is essential for the greater good of these patients, and the society as a whole. Cons Besides the legal, ethical and religious aspects, the precarious nature of the DNR order also makes it disagreeable. Even if the DNR order is duly signed and approved by the physician and the patient, it is still not absolute in nature. The DNR policy still remains unclear on several fronts. A patient with a legitimate DNR order might undergo a cardiac arrest while he is being operated upon due to a medical error. The physician cannot override the order unless he has absolutely compelling evidence which suggests that a DNR is against the patient’s wishes (Ross, 2003). If the physician does respect the DNR, it might actually amount to violation of the patient’s desires for he envisaged that the cardiac arrest would occur naturally and not due to a human error. In other cases, the rampant advancements in the medical field might lead to the discovery of a hitherto unknown treatment for a particular disease. When the patient agreed to a DNR, he might not be aware of the existence of such a recent discovery. It is precisely because of these uncertainties that the medical personnel step aside when they have to act upon a DNR. There is an obvious possibility of a malpractice charge or a case of medical negligence. Another troubling feature regarding the DNR is the patient’s inability to think lucidly in the situation that he is under. Quite often, the patient is under a variety of medication, some of which might alter his psychological state, which might prevent him from making a well-informed decision. It is hard to judge, both for the physician and the relatives if the patient is stable and conscious enough to take a step as critical as this. The following occurrence in the state of Indiana is a testimony to that fact. A legal case was filed against a physician who issued a “no-code” status on his patient, Mr. Payne, thus rendering him incompetent to sign the DNR order. Therefore, his family was given the power to decide. But the nurses’ statements provided strong evidence that the patient could communicate even a few minutes before his demise, and should have been consulted before signing the DNR order. Further, his medical records stated that he had suffered a similar cardiac arrest in the recent past and had recovered soon (Pozgar & Wallace, 2003) These instances only reiterate the uncertain character of the DNR order. In addition to the legal and medical aspects, there is also the ethical dimension. The right to die might still be debatable but the right to live has been a fundamental human right since time immemorial. No physician can deny the fact that there is always a slim chance of revival. And some families might want to hope and wait for that miracle to happen. The religious angle is also intimately related to the ethical one. Firm believers of God prophesize that only the Almighty has the ultimate power to put an end to human life. They argue that death is a natural phenomenon, and not a human induced one. Conclusion People are bound to have ethical and religious reservations against DNR. It also draws criticism on the legal and medical front, as it can easily be misappropriated. Nevertheless, economically, it is the need of the hour for the debilitating healthcare sector. Under the Social Security Admission scheme, the hospital is bound to pay a share of the expenses on critical care for insured patients. An ageing population could increase this expenditure manifold, which could lead to collapse of the healthcare industry as a whole. Also, one has to comprehend that the terminally ill patients prefer quality over quantity when they sign their DNR forms. Irrespective of the justifications provided to substantiate either side of the argument, DNR or the Right to die is an issue which will invite debate and controversy perennially. References American Medical Association. (2005, August 22). Do Do-Not-Resuscitate orders endanger patients? Retrieved 2 August 2008 from http://euthanasia.procon.org/viewanswers.asp?questionID=189 Center for Disease Control and Prevention (2005) Life Expectancy. Retrieved 1 August 2008 from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf . Murphy, P., & Price, D. (March 2007, P17-20). How to avoid DNR miscommunications. Nursing Management , Vol. 38 Issue 3, 2p; (AN 24468503). Pozgar, G. D., Pozgar, N. S., & Wallace, R. B. (2003. P. 302). Long – term Care and the Law: A Legal Guide for Health Care Professionals. Jones & Bartlett. ISBN: 0834202891. Ross, L. F. (2003, September 9). Do Not Resuscitate Orders and Iatrogenic Arrest During Dialysis: Should "No" Mean "No"? Retrieved1 August 2008 from Wiley InterScience: http://www3.interscience.wiley.com/journal/118842896/abstract Social Security Adminstration (July 1997). Social security programs in the United States. Retrieved 2 August 2008 from http://socialsecurity.gov/policy Read More