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."

Tags:do-not-resuscitate, orders, DNR, CPR, medical, ethics

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. "

Tags:cpr, hospital, nursing, home, medical, staff, cardiac, arrest, emergency, urgent, breathing

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

Abstract
A DNR order is an advance directive which refers to a means to communicate a person's preferences about life-sustaining treatment in case they should ever become incapable of expressing those wishes (CNO, 1999). All nursing actions are to be guided by ethical principles and standards of practice. Resuscitation is a standard and is based in respect for client choice and well-being, maintaining fidelity or commitments, truthfulness, and fairness (CNO, 1999). Other core principles and issues in this situation are autonomy, informed consent, and accountability.

From the Paper
"A DNR order is an advance directive which refers to a means to communicate a person's preferences about life-sustaining treatment in case they should ever become incapable of expressing those wishes (CNO, 1999). All nursing actions are to be guided by ethical principles and standards of practice. Resuscitation is a standard and is based in respect for client choice and well-being, maintaining fidelity or commitments, truthfulness, and fairness (CNO, 1999). Other core principles and issues in this situation are autonomy, informed consent, and accountability. This paper will..."

Tags:ethics, principles, standards

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."

Tags:medical, treatment, suffering, prolong

Abstract
An illustration of the Do Not Resuscitate or DNR orders, as they are known as in the abbreviated form.

Tags:do, not, resuscitate

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."

Tags:medical, legal, ethics, morals, euthanasia, death, health, nurses, nursing

Abstract
The paper explains that advance directives refer to formal documents or verbal statements which determine how a patient's healthcare decisions will be made in case the patient loses the ability to direct the decisions himself. The paper looks at the laws regarding advance directives in a written format, the problems posed by verbal DNR orders and the battery charges that could be faced by nurses or physicians who try to resuscitate a patient in a situation where an explicit DNR order is present. The paper also discusses advance directives' considerable moral importance and benefits as well as their limitations and risks. The paper concludes with the assertion that doctors must discuss the benefits of advance directives with their patients and patients must also become more comfortable with the reality of death and the need for advance care planning.

From the Paper
"Through a living will a patient can himself direct what kind of treatment will be acceptable to him in case he loses his ability to make decisions. Living wills come into operation only when patients lose the ability to communicate to others or when the situations specified in the LW document take place. Such situations specified in the living will may include persistent vegetative state, a terminal illness or inability to take independent decisions. Living wills may also specify what kind of treatments should be allowed or not allowed or may simply specify general goals. The specified treatments may include nutrition, artificial ventilation, artificial hydration and CPR. Through a health care power of attorney, patients can designate a proxy or a person who can take decisions on their behalf when they become incapacitated. This kind of advance directives provides more flexibility than living wills since it is not possible to anticipate all kinds of medical conditions and treatment alternatives that a person may undergo or require in the future. Do-not-resuscitate -- DNR advance directives are a sort of advance directives which explicitly specifies the withholding of techniques like defibrillation, artificially supplied respiratory support, specifically closed-chest cardiac message and CPR. ("Advance Medical Directives.", n. d.); (Feldman; Christensen, 2007)"

Tags:Patient, Bill, of, Rights, DNR, order, treatment, battery

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.

Tags:utilitarianism, dnr, decisions