Ethical dilemmas surrounding DNR (Do Not Resuscitate) orders
Ethical dilemmas surrounding Do Not Resuscitate orders
In carrying out their duties, health care givers face many ethical issues that sometimes affect their personal lives. These require that they make ethical decisions, which may affect them and their patients, as well. An example of a situation that puts the health care givers into an ethical dilemma is the application of the Do Not Resuscitate, which seeks to counter the invasive and painful experience of Cardiopulmonary Resuscitation. A health care profession needs to make a critical decision on when he or she should obey the order and on when he or she should ignore it. The purpose of this paper is to discuss these ethical and legal issues, and give recommendations of addressing them.
In the 1950s, the world witnessed the development of Cardiopulmonary resuscitation, by closed chest massage, to help patients who suffer cardiac and/or unexpected respiratory arrest. Since its invention, it has been the standard practice for medical facilities unless health care providers receive a restraining order. This restraining order is for curbing the invasive nature of Cardiopulmonary resuscitation. According to Brewer, this practice is one of the invasive medical practices, which healthcare professionals can carry out without seeking consent (2). Although this medical intervention practice saves life to some extent, the percentage rate of survival to discharge is relatively small. This indicates this medical intervention method does not always save lives (Brewer 4). This realization led to a new phenomenon that has become the heart of debate within the medical field.
Studies into the effectiveness of Cardiopulmonary resuscitation, indicating that it was not as effective as the media had displayed it, led to the Do Not Resuscitate orders and position papers in the early 1970s (Brewer 5). The patient in question is the one who initiates A Do Not Resuscitate order, and it means that healthcare professionals should let the patient die naturally if he or she experiences respiratory or cardiac arrest (Zinn 1). The argument is that patients should die peacefully without undergoing painful and ineffective treatment. The Do Not Resuscitate orders are usually well documented indicating the patient's wishes, and doctors often determine the Do Not Resuscitate decisions in the last days of the patients and in cases where physicians do not understand a "patients' preferences regarding resuscitation" (Brewer 8). Many controversies surround the newer development, whose main goal is forgo aggressive and invasive medical interventions that may be futile in terminal illnesses.
Depending on the locality, health care professionals may or may not give other medication for patients with a Do Not Resuscitate order. Whereas some doctors may only hold back chest compressions, they may still provide sophisticated care like mechanical ventilation. On the other hand, other doctors may withhold any further treatments for a patient in possession of a Do Not Resuscitate order. The unpredictable appliance of, Do Not Resuscitate orders, implies that some patients may not get the best possible care as soon as providers are aware that the patient has a, Do Not Resuscitate order. Some healthcare providers will even pay no attention to fundamental care to patients with Do Not Resuscitate orders.
Most critically ill patients fall somewhere between being terminally ill and an unexpected respiratory or cardiac attack. This poses a challenge of uncertainty to the health care professionals concerning the ethical considerations of resuscitation (Brewer 10). Another ethical dilemma with regard to the application of Do Not Resuscitate orders is that medical interventions range from "comfortable measures only" to aggressive measures, but most patients fall in the precinct of ambiguity. According to Brewer, this raises a number of questions to the health care professionals. Such questions include whether the patient should undergo Cardiopulmonary Resuscitation in case of a cardiac attack, the implication of a Do Not Resuscitate order, whether they should suspend treatment, or whether a Do Not Resuscitate order is an implied admittance of giving in. Other questions with regard to this dilemma include the implication of a written Do Not Resuscitate order, whether they should leave patients with Do Not Resuscitate orders to die, and how the patients and their families will view its application (Brewer 11).
Effective pre-arrest management strategies for Do Not Resuscitate patients may confuse the healthcare providers creating ethical hazards while caring for patients in critical conditions (Sanders et al. 8). Clinicians may feel that they should...
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