Abstract This paper explains that the threatened birth of an extremely preterm or anomalous infant presents complex medical, social, and ethical issues for the family and the involved physicians. The author points out that cardiopulmonary resuscitation in the delivery room is a modality that presents clinicians with significant ethical issues because the decision to not resuscitate is made rapidly and most often without the advice of a bioethics committee. The author suggests the importance of facilitating change in the care of pregnant women and marginally viable infants resulting in parents developing an understanding of the risks that their newborn faces if delivered and resuscitated.
Table of Contents
Introduction
Media
Legal
Ethical
Economics
Facilitating Change
From the Paper "The current and most frequent policy on resuscitating neonates of marginal viability is from the "Textbook of Neonatal Resuscitation". It suggests the non-initiation of resuscitation for newborns less than 23 weeks gestation and/or 400 grams in birth weight. It consists of resuscitating infants of 23- 24 weeks or greater unless they have a previously diagnosed lethal anomaly. Current practice is to not resuscitate infants with congenital anomalies that are incompatible with life (Bloom, 1993). The fetus of 23 weeks is considered a possible but unlikely survivor. Since there is some evidence of survival of 23 week infants, various hospitals have adopted the policy of resuscitating these fetuses. Very low birth weight (VLBW) infants that survive represent a small percentage of those delivered."
Abstract This paper proposes research to investigate the importance of the presence of family members during episodes of medical treatment. It specifically discusses whether families should be allowed the option to stay in the room when resuscitation is being provided for loved ones. It discusses what the presence of family members in the room during therapeutic intervention can do to change the outcomes and if their presence will have any effect on the process. The paper also discusses the effect of the family's presence on the staff members and whether there may be any legal ramifications. Finally, the paper questions whether family members in the room improve or impair the resuscitative attempts.
Table of Contents:
Problem Statement
Related Research and Literature Review
Objectives
Research Procedure Methods
Outline for Research Study
Materials and Staffing
From the Paper "For the patients we interview we will focus primarily on those patients preparing for elective surgery which none-the-less will likely require intensivist intervention after the procedure. Every member of the staff as well as intensivists and anesthetists will be provided with a written, anonymous questionnaire and asked to return the same within twenty-four hours. Patients between the age of 18 and 85 will also be recruited. The patients will be those who have been scheduled to perform elective cardiac or vascular surgery where the patient would have to spend a period of post-operative recovery in the intensive care unit. Each patient will be asked to complete the questionnaire in the presence of one of the researchers. This will be a questionnaire with specific questions but will also allow the patient space to make comments. Only patients who have next of kin willing to participate will be allowed to participate, since a questionnaire will also be provided to the family members and paired responses will be analyzed."
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
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 discusses cardiopulmonary resuscitation,often abbreviated to CPR, a potentially life-saving procedure to temporarily restore blood flow and breathing to a person whose heart and lungs have stopped. It also looks at how the phrase is sometimes used to refer to interventions used to attempt to save patients already hospitalized, as well as to skills any person can acquire and use on a loved one or total stranger in an emergency. It looks at the discovery and development of the process, whether it actually works, and also discusses its limitations.
From the Paper "CPR by itself is unlikely to save a person's life. The best outcomes occur when CPR is followed by defibrillation as soon as possible followed by intensive medical support at a medical center. Unless CPR is begun within 4 - 6 minutes of when breathing has stopped, the person is likely to suffer significant brain damage, so early intervention is crucial. If there is only one person who is not strong enough to do both breathing and chest compressions, then chest compressions should be done. If the person's hear resumes beating, often the person will begin breathing again as well. Together, the American Heart Association and the American Red Cross train more than five million people each year in CPR (De Milto, 1999)."
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 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 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 In this article, the writer notes that the roots of modern anesthetics may be traced back to the 19th century, with the successful isolation of cocaine from coca leaves. The writer points out that one type of amino amide that is far less toxic than cocaine is bupivacaine, which was eventually synthesized in 1963. The writer maintains that the long-lasting anesthetic effects provided by bupivacaine have been shown to cause cardiovascular toxicity at relatively low serum levels that are approximately the same as levels that cause toxicity in the central nervous system. The writer then discusses issues related to toxicity caused by the bupivacaine including reactions, prevention and resuscitation techniques. The writer concludes that the research supports possible clinical interventions using lipid infusion in the treatment of cardiac toxicity due to exposure to bupivacaine.
Outline:
The Development and Use of Bupivacaine
Toxic Reactions Associated with Bupivacaine
Case Studies Detailing Toxicity Associated with Bupivacaine
The Prevention of Bupivacaine-induced Toxicity
Bupivacaine and Positive Cardiovascular Effects?
Resuscitation Techniques Following Bupivacaine Intoxication
Lipid Infusion as Resuscitation for Bupivacaine Toxicity
From the Paper "Overall, bupivacaine is considered to be among anesthetic agents that are more likely to cause states of cardiotoxicity. In animal studies, bupivacaine was demonstrated to be four to sixteen times more likely to cause cadiovacular toxicity than lidocaine. However, bupivacaine will continue to remain as a primary local anesthetic agent used by clinicians, which indicates a need for knowledge and awareness as to how to most effectively treat toxicity when it arises."
"Clinicians must adhere to proper dosages of anesthetics and correct sites of administration in order to reduce chances of the occurrence of toxicity. More recently, research has yielded the development of anesthetic agents that have reduced toxicity in comparison to bupivacaine."
An analysis of the importance of certification for instructors of PALS (Pediatric Advanced Life Support) and NRP (Neonatal Resuscitation Practitioner).
Abstract This paper discusses why it is important for a respiratory practitioner to gain certificates as a PALS (Pediatric Advanced Life Support) instructor, or a NRP (Neonatal Resuscitation Practitioner) instructor. The paper examines why it will advance the practice of the respiratory practitioner. The paper provides a look at what each certificate means to the medical professional, and what the guidelines for each are.
From the Paper "The PALS course teaches guidelines and requirements for resuscitating a child who is in a trauma situation. These requirements include knowing the conditions of risk for cardiopulmonary arrest, the parameters that indicate cardiovascular compromise in the patient, and strategies for prevention of cardiopulmonary arrest in children. Students must demonstrate skills of establishing and maintaining an airway in children. They must also identify the effects of multitrauma in children, and know the sequence and priorities of newborn and pediatric resuscitation. Proper techniques of management and maintenance of proper alignment of the cervical spine in the patient."
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.
Abstract This paper examines how death has become more clinical and more involved with medical intervention and how, as such, it has been removed from our everyday lives. It discusses how medical professionals of every kind must deal with death and dying issues on a daily basis. It provides a literature review covering aspects of of euthanasia, cardiopulmonary resuscitation, and living wills. The common themes identified in studies in end-of-life decisions are discussed and analyzed, and conclusions are reached.
Outline
Introduction
Abstract
Euthanasia
Ending a Patient's Life
Patient's Choice: Consent/Autonomy
Living Wills
Do Doctors Really Act Beneficently?
Conclusion
From the Paper "Do the patient's desires have any bearing on the outcome of the case? Can the patient be considered to have given informed consent in the matter of the administration of a lethal dose of a lethal drug? In the United Kingdom, all medical professionals are bound by very strict rules regarding informed consent. All patients are considered to be competent to provide consent unless they demonstrate otherwise. In all cases, the medical professional must ask themselves if the patient can understand the decisions being recommended and make a proper decision with the information which has been provided. It must also be understood that a patient who refuses treatment or makes an unexpected decision when full information has been given is not necessarily incompetent, but an unexpected decision may show the need for further explanation by the professional."
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. "
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."
