Abstract This paper discusses unilateral DNR, or do-not-resuscitate orders, placed in the chart of patients without the consent of the patient or the patient's family. They are used when CPR would be futile. The paper then describes the ethical controversy involved with this issue--that many fear physicians could abuse this practice. The author argues that policies must be in place to safeguard against abuse. A model unilateral DNR policy is presented.
Outline:
Introduction
Review of Literature and Analysis
Explore Options
Apply Rule Ethics
Position
Considerations For Practice
Conclusion
From the Paper "In the early 1960s, CPR or cardiopulmonary resuscitation came into use. CPR was originally developed for patients who suffered a cardiac arrest secondary to anesthesia. The practice of CPR quickly became the standard of care for all patients suffering cardiac arrest. With advancements in technology the norm has become aggressive treatment until death. From the earliest days of CPR, few issues have been more contentious than whether a physician may determine, without patient or surrogate consent, that CPR is not indicated(Leonard, 1999). According to the Journal of Critical Care Medicine, by the late 1960s articles began to appear in medical literature, which described the agony many terminally ill patients experienced from repeated resuscitations that only prolonged their death (Burns, 2003). Because of the suffering caused by CPR performed on patients with terminal illnesses, hospital staff began using the unethical practice of slow codes or show codes. Orders not to resuscitate evolved in the early 1970s."
Abstract The paper discusses the bioethics issue of the do not resuscitate or DNR order. The paper discusses the importance of an individual under medical care actually understanding the implications of this document. The paper contends that the DNR order itself must be institutionalized as well as the procedures used to obtain signatures.
From the Paper "In my experience as a health care provider I have seen many a document signed without regard to making certain that the individual has the right to sign the document (especially in the case of family signing for individuals in emergency care situations where the individual cannot sign for him or herself) and in situations where documents were signed by individuals who did not fully understand the implications or meaning of them. I have also seen many documents needing a signature of a witness be signed by medical professionals who were not actually present when a signature was obtained from patient or family. As this is usually thought of as an adjunct to their actual work as clinical providers they do not seem to give the significance of their actions or the implications of the documentation much regard."
Tags: signature, documentation, bioethics, care, provider, patient, rights
Abstract This paper explains why it is unethical and impractical to expect people to sign a DNR order as part of their health care plan when, at the time of signing, they are perfectly healthy. It uses real medical cases illustrating why doing so is problematic and to argue that DNRs, while justified at times, can often be unsuitable for persons to specify in advance for any medical condition that may arise.
From the Paper "A 'Do-Not-Resuscitate' - DNR Order from an adult patient directs the medical staff not to attempt to restore the patient if his breathing or heartbeat has blocked. This means that doctors, nurses and other health care practitioners will not start emergency procedures like mouth-to-mouth resuscitation, external chest compression, electric shock, and insertion of a tube to open your airway, injection of medication into your heart or open chest. Additionally, the Health Care Proxy Law permits an adult patient to employ someone to make decisions about DNR and other treatments if the patient is not capable of doing the same. Cardiopulmonary resuscitation - CPR refers to the medical procedures employed to revive a patient's heart and breathing when the patient experiences heart failure. CPR may include minor efforts such as mouth-to-mouth resuscitation and external chest compression. Sophisticated CPR may include electric shocks, inserting of a tube to open the patient's airway, injecting medication into the heart and in complex difficult cases, open chest heart massage. "
Abstract The paper overviews ethical concerns and the nursing practice standards in palliative care settings. The paper focuses on the ethical implications of the DNR (do not resuscitate) order from the nursing perspective. The paper maintains that good palliative care is all about reducing the distress of the patient as much as possible and helping him attain a peaceful end. The paper asserts that this can sometimes demand a sense of moral detachment.
Outline:
Introduction
The DNR (Nursing Implications)
Conclusion
From the Paper "The DNR (do not resuscitate) order is a request which advices against the use of Cardiopulmonary resuscitation for revival of the heart function of the patient who has a cardiac or pulmonary arrest. Typically, the request for DNR is given as an advance directive by the patient, but in cases where the patient is in comatose state the physician discusses it with the family before recording the DNR order. [Hanna Mari Hilden et.al, 2004] The DNR order in effect takes away the obligation on the part of the attending nurse or the physician to revive the failed heart using CPR. Nurses in palliative care have to face cases where the DNR is applied consistent with the patient's autonomy."
Tags: moral, detachment, palliative, care, illness, pulmonary, arrest
Uses the examples of John Stuart Mill and Jeremy Bentham to demonstrate that utilitarianims supports the ethical and moral "do not resuscitate" decision.
1,150 words (approx. 4.6 pages), 3 sources, 2002, $ 44.95
Abstract This essay discusses how do not resuscitate (DNR) decisions from a patient standpoint can be proven morally and ethically upon examination through the principles of utilitarianism. The examples of John Stuart Mill and Jeremy Bentham epitomize this reality.
This paper analyzes the arguments for and against a terminally ill individual's right to die as well as the legalities surrounding the medical community's do-not-resuscitate policy (DNR).
Abstract This paper examines the ongoing and controversial debate regarding euthanasia. This paper discusses the rights of terminally ill patients who opt to refuse treatment as well as the various legal and moral ramifications surrounding this particular topic. This paper delves into the views, policies and cost control measures of health insurance companies regarding DNR policies. This paper discusses both sides of the assisted suicide issue as it pertains to terminally ill individuals. This paper explores the medical community's reputation related to the improving quality of care given to terminally ill patients. This paper discusses the medical community's concern regarding inherent or potential disciplinary actions, malpractice liability as well as criminal prosecution surrounding physician assisted suicide. This paper also analyzes the existing yet contradicting laws which give patients the right to accept or refuse care yet do not encompass the rights of those actually delivering the care.
Table of Contents:
Introduction
Arguments For
Arguments Against
Conclusion
References
From the Paper "Consider that the United States healthcare system includes many health plans, physicians, hospitals, clinics, consumers, and public health programs. These entities are all usually focused on life and health recovery. But, the healthcare community also incorporates a very large hospice aspect which is utilized by both insured and uninsured patients that are terminally ill. As our nation's median age of the overall population steadily rises, more Americans will need the services provided by hospice organizations - or, they should be allowed to choose the option of do-not-resuscitate or "Right to Die" as valid approaches to end stage life. Once patients are to a point where they can be assured that there are no possibilities and or options left for curing their fatal disease for example, allowing the end to come more naturally may actually be more humane. This approach relieves many burdens such as when a financial burden is inadvertently put on the surviving family if life is extended artificially."
Abstract This paper introduces, discusses and analyzes the topic of do not resuscitate (DNR) orders and living wills (also known as "advance directives"). Specifically, it discusses the ethics of these orders and how they relate to medical law and professional ethics. The paper looks briefly at where patient rights and medical ethics blend and where they diverge.
Table of Contents:
Introduction
Body
Conclusion
Definitions
From the Paper "Ultimately, the woman's condition deteriorated, and she died within 24 hours of the first legal and medical meeting regarding her case. However, the problem brings up many ethical questions. Who is ultimately responsible for advance directive orders? In this case, the woman could not speak for herself, and the closest relative was her husband, who made his wishes clearly known. However, the rights of the fetus also had to be considered. The authors of the case study note, "However, the rights of the unborn are still widely debated, and it is far less obvious that they can outweigh the well-established right of competent adults to be free of unwanted and burdensome medical treatment". This ethical question is difficult to decide, and even more difficult to implement. In this case, the doctor felt giving CPR to the woman would only prolong her life for perhaps minutes or hours, and would do nothing to greatly prolong her life and the life of her unborn child. If the age of the fetus had been different, this case probably would have ended in the courts."
Abstract In this article, the writer discusses difficulties with do not resuscitate orders (DNRs), advanced directives and medical power of attorney. The writer notes that decisions regarding these issues are often left to the nurse to make, as a great deal of discretion is afforded the nurse, especially in the triage aspect of emergency room care. The writer points out that emergency room care requires quick thinking and logical judgment utilized to make the best possible decisions for a critically ill patient, that has not yet been medically stabilized. The writer claims that it is the job of the emergency room nurse and other staff to err on the side of caution and withhold any treatment that might further compromise the patient.
From the Paper "The work expresses the problem, as it is associated with the view of palliative care as doing nothing. It is clear that palliative care is a viable medical response to end of life scenarios and should be utilized in cases where it is indicated, by the wishes of the individual and his or her legal voice. Palliative care being a set of treatments that focus not on life saving techniques but on those that impart comfort and treat uncomfortable symptoms, such as acute pain. The author indicates that the problem lies in the fact that this society, and especially the medical industry (here sighting new doctors) are consummate death deniers, seeking life saving options above all others. In the case specific to this write up the treatment change has certainly not gone to the point of a complete denial of patient wishes, as the denial of one form of palliative care, erring on the side of caution does not constitute full application of life support, though without patient advocates, as are seen by the present family, there is a danger of just such an occurrence."
Tags:DNRs, physician, palliative, care, medication
Abstract This paper explores the issue of "Do Not Resuscitate" orders, commonly known as DNR's. While the main issue discusses the legal ramifications, there are other issues raised such as the use of health care resources and the ethical consequences of the inaction. The paper defines DNR as "if the patient's heart stops, there will be no efforts to revive that patient", in other words the patient will simply be allowed to die naturally, with no medical intervention.
From the Paper "The first step here is to clarify what the "do not resuscitate" order means. It means that if the patient's heart stops, there will be no efforts to revive that patient. The patient will simply be allowed to die naturally, with no medical intervention. The Royal College of Nursing, along with other professional organizations, noted that these orders are important documents that should only be considered after discussion with the patient and family members or others close to the patient."
Abstract This paper explains that, although living wills and "Do Not Resuscitate" (DNR) orders are common methods used by patients and their families to indicate their wishes during times of hospitalization and treatment, there are so many exceptional cases and circumstances surrounding these issues that they are continually controversial and test the bioethical standards of the medical and legal communities. The author points out that, while every state now recognizes advance directives and DNRs, they can be interpreted differently in each state due to laws and legislation. The author also explains that many physicians, fearful of legal reprisals, judge each advance directive on a case-by-case basis and are reluctant to abide by the directives if the case is even the slightest bit unusual or questionable.
From the Paper "To a family member or patient, the idea of a Living Will or "Do Not Resuscitate" order many seem binding and unquestionable. However, many circumstances challenge these orders, and the ethics of carrying them out are sometimes convoluted and questionable. For example, one cited case involved a 21-year old pregnant female diagnosed with "PCP (pneumocystis carinii pneumonia), right parietal infarct (a blood clot in her brain) with left hemiplegia, and CMV (cytomegalovirus, an infection similar to mononucleosis)". It was discovered the woman was also HIV-positive, and there was a great possibility her unborn child was also HIV-positive."
Abstract In the first part of the paper current definitions of brain death are examined and the pros and cons associated with these positions are discussed. The second part of the paper details some of the ethical concerns associated with how we determine death in the context of nursing practice.
From the Paper "There are three main definitions of death: i) traditional, ii) whole brain definition, and iii) higher brain definition. The traditional definition of death is one that is held by virtually all individuals (medical professionals and lay-people) consisting of the absence of respiratory and circulatory activity. The whole brain definition of death tends to be differentiated into two views: a) the primary organ view, in which death is defined as the absence of lower brain activity, and b) the integrated system view, in which death is defined as the absence of lower brain activity and respiratory/circulatory activity. The higher brain definition of death is classified as the absence of higher brain activity. The main impetus surrounding the move towards defining death in a more precise fashion arose from issues such as resource allocation, organ transplantation, and withdrawal of treatment. As such, the way in which we define death will have important ethical implications for patient care ? specifically, its affects on nursing practice and incorporating these concepts concerning, for instance do not resuscitate (DNR) orders (Glendenning 1998)."
Abstract This paper discusses the problems of the residents of Badger, Wisconsin, who are battling to drink contaminant-free water, trying to avoid poisoned fish in Ballistics Pond, and holding their breath while old ammunition sites are burning dinitrotuluene; and yet the government continues to both push and ignore the very destruction that ails them. The author continues that the Department of Defense is spending money on additional armed submarines to continue polluting the oceans. The paper states that, if the United States government wants more money for defense, it should consider taking up effective listening in regards to what might matter to the people in the world.
From the Paper "The budget proposal mentioned becomes even more sickening when you explore what has happened in Badger further. Badger citizens cannot even drink their own water. According to The Citizens for Safe Water around Badger, "Late on Wednesday, March 3, the Army received results from monitoring wells sampled during the December 2003 round. Several monitoring wells located along the south boundary of Badger detected DNT in groundwater near the intersection of Keller Road and Highway 78 in Sumpter township. DNT levels were detected at 0.02 and 0.05 ppb (parts per billion). The safe drinking water standard for DNTs is 0.05 ppb." The detection of this cancer - causing agent in the Badger water prompted the military to hurry up and wait. Time has elapsed, dollars have been spent, and there is still no cure."
This paper relates the history and function of the Illinois Association of Park Districts (IAPD) and other agencies relating to parks, recreation, and wildlife conservation.
Abstract This paper relates that the Illinois Association of Park Districts (IAPD)
was founded as the Illinois Association of Conservation and Park Districts 75 years ago to establish and protection parks and to conserve wildlife. The author points out that the historic "Park Law Codification Bill", signed in 1951, combines all the various laws pertaining to the issues of park conservatism into one single section of the state law. The paper relates that, today, each of the more than 40 park districts, forests, and conservation parks in the state of Illinois has a police force to patrol, routinely enforcing laws regarding recreation, hunting, and boating, and especially the use of drugs and alcohol.
From the Paper "The DNR or the Illinois Department of Natural Resources states that its mission is to protect and manage and to conserve the various natural resources that the state of Illinois can very proudly boast of, and to provide those recreational opportunities to interested people that would not harm or spoil these natural resources in any manner. The Educational Department of the DNR was launched in the year 1995, with the primary aim of the development of educational methods and of the training methods involved in the conservation of natural resources of Illinois. It also was to provide hands on training for those persons wanting to indulge in the various outdoor activities that Illinois offers, such as snowmobiling, boating and hunting methods."
Abstract This paper describes how the process of do not resuscitate (DNR) can be the source of an ethical dilemma for healthcare workers. The writer discusses a specific case that arose at Euclid Hospital that shows how nurses can be torn between their loyalty to the patient and to hospital policy. Euclid Hospital's risk management policy and ethical decision-making model are also described. The writer concludes that ethical dilemmas can be resolved by improved communication and by assessing each case individually.
Outline:
Introduction
Do Not Resuscitate
Policy vs. Patient Care
Ethical Responses
Risk Management
Ethical Decision Making Model
Conclusion
From the Paper "The primary nurse for this patient did initiate CPR. Family was not present and within two minutes the house physician was on the unit and a DNR order was written and life sustaining efforts ceased. The primary nurse in this situation acted under the ethical precept of deontology. Deontology is one system of ethical decision making. The theory is based on moral rules and unchanging principles. Deontology is based on the belief of standards present for the ethical choices and judgments that nurses make (Aiken, 2004). This approach would justify the nurse initiating CPR on this patient because she was following legal and professional rules."
Tags: nonmaleficence litigation, intensive care unit, clinician, healthcare provider, caregiver
