The keys to the policy are severely chronic illness as represented by the patient's declining functionality; and that death is imminent. It is a policy that advocates the right of a patient to forego life sustaining technology and intervention in what is constituted as legal death when the patient's heart stops and, without CPR which could ostensibly revive the patient to life, is final death for the patient. The policy resolves decisions of the healthcare provider and the healthcare staff to act in response to the patient's cessation of life.
Today, unless a DNR order is signed by the patient or the patient's family rights designee, then the hospital staff responds to the cessation of patient life with life-saving CPR techniques. The mandate would eliminate this automatic response in cases where there was no DNR on file if the patient's condition of chronic illness is one that will result in imminent death even if the life reviving CPR is successful. This means that patients with conditions such as cancer, heart disease, and other diseases of major organs, or conditions which, like that of Terri Schiavo, whose bodies can be sustained by artificial support systems, but who would otherwise die; would be allowed to die without the intervention, and could die in peace and dignity through natural life and death processes.
It would bring to an end the public involvement, and religious organizations' involvement in the end-of-life decision making process. The process of dying would become one that is based purely on a patient's medical condition, choice, in cases where the DNR is part of the patient's care plan, and CPR would no longer be an automatic emergency response of medical personnel in cases when a patient's life ceases naturally.
The policy is not a vehicle for arbitrary decision making by the family or by medical personnel. It must be predicated on informed decision making, and that information must be made available to the patient and to the patient's family. The question of whether or not the medical provider or provider personnel failed to act appropriately should not rise as a question, because the patient and the family will be provided details of how that action is decided before the need for such action, or lack of action, arises. The DNR process must be a part of the EOL counseling provided to patients and families in settings other than hospice settings where the nature of the setting denotes an understanding that death is imminent.
A specific and distinct document that outlines the mandate should be part of every admission hospital, nursing home, long-term care facility, and hospice admitting package. The form should require a criteria-by-criteria review with the patient or the patient's designated healthcare decision maker, and require the signature of both the EOL counselor and the patient, or the patient's designated decision maker and authorized signer for services and care. During the course of care, the patient and/or patient's family should have access to an EOL counselor to whom questions can be directed, as well as the patient's attending or primary care physician.
A DNR mandate will eliminate future court proceedings, public involvement, and Congressional oversight...
Resuscitate (DNR) What is a Do Not Resuscitate (DNR) order? First used about fifty years ago, the do not resuscitate (DNR) order continues to elicit questions and discussion among medical experts and patients. The do not resuscitate order is a directive from a patient who specifically refuses consent for certain forms of medical interventions related to life-saving actions by hospital personnel. The presence of the DNR order makes it important that
Deontology and DNR: Addressing the Issue Introduction Do Not Resuscitate (DNR) orders are an issue for a number of care providers in hospitals, especially those who work within the context of hematology and oncology care. As Weissman (1999) notes, DNR is a stumbling block for many nurses and nursing students: for example, he states that his students unanimously struggle to understand the purpose of asking terminally-ill patients what their preferences are on
A recently enacted policy, however, enforces the use of a dogmatic and uncompromising ideological speech as a standard replacement of informed consent (Minkoff & Marshall, 2009). The policy requires a list of statements, considered "facts," which discuss risks, benefits and alternatives. These focus largely on risks, misinformation and implied government disapproval. The use of this script compels the physician to commit an ethical and professional wrong, deceive his patient with
resuscitate orders and living wills (also known as "advance directives"). Specifically, it will discuss the ethics of these orders, and how they relate to medical law and professional ethics. Living wills and do not resuscitate orders (DNR) are common methods for patients and their families to indicate their wishes during times of hospitalization and treatment. However, there are so many exceptional cases and circumstances surrounding these issues that they
In applying this article to the nursing field, it appears that combining therapies with surgery can enhance care to surgical patients. The article reaction is preoperative anxiety can be reduced with holistic nursing. Rosenberg, S. (2006). Utilizing the Language of Jean Watson's Caring Theory Within a Computerized Clinical Documentation System. CIN: Computers, Informatics, Nursing. This article describes and critiques a healthcare facility that was part of an eight-hospital organization that adopted
According to this second view, contemporaneous autonomy trumps precedent autonomy because honoring precedent autonomy imposes preferences and values of a different person, the formerly competent self (Buccafumi, p. 14). The role that patient's families, doctors, health aides, pastors, chaplains and administrators, health educators and others play is crucial. Few people have executed an advanced directive, much less appointed a healthcare power of attorney by the time they enter a hospital
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