Do-Not-Resuscitate: Legal and Ethical Issues
Most cultures value life and bringing persons back from the dead is a popular subject of many fictional books. However, as technology evolves and the story of Frankenstein reborn with a bolt of lighting has come true with the external or implanted defibrillators, the natural process of death slows as much of society gains the knowledge to live longer than nature intended. The Red Cross Association taught many organizations like the girl and boy scouts the methods of mouth-to-mouth resuscitation and Cardiopulmonary resuscitation or CPR, a manual manipulation of the heart, as life saving methods for drowning, electrocution or heart attacks. First aid for laypersons to save lives as well as doctors and no one is thinking that the person did not want to live after such an event. Thus, came the dawning of the provision of the do-not-resuscitate (DNR) order or provision stating not to initiate CPR if the individual is not breathing or the heart stops. Individuals wishing not to be resuscitated after clinical death can choose to place that advance directive in a living will as a do not resuscitate order directing that no CPR is to be attempted. The ideal of persons exercising their right to autonomy or their right to make decisions about healthcare before they are incompetent to do so is sound, but the DNR is burdened with controversy, complicated and emotionally charged.
Eventually, the DNR directive became standard in hospice and end of life care, which led medical and state authorities to create and enforce clearly affirmed policies about when to delay or ensue with the action. In these policies, emphasis on the patient autonomy and surrogates for the patient can possibly take precedence over the decision of the doctor as a priority decision-maker, especially in the moments of impending death. During this time of incapacitation, the intentions of the patient are important in necessitating the resuscitative/CPR order. However, in an emergency, a controversy centers on who should have the authority over the making of the DNR decision (Olver, I., and Elliott, J., 2008). Many concerns about the conflicting legal and ethical issues of the Do Not Resuscitate order subsist because of the potential deprivation in quality of care and the moral value of life. These apprehension s are present because of the uncertainties that lay between the doctors and family for the decision-making authority over the patient. Legal/Ethical Issues of DNR
Originally, the DNR was a response to the confusion in situations involving CPR. When a person in cardiac arrest goes to a hospital or a paramedic gives emergency medical care to a person in their home, the default practice is to give life-saving CPR. Refusing to perform Cardiopulmonary resuscitation or CPR on a person in critical status is the same as doing nothing to save a life, which holds the possibility of murderous act unless the individual holds proof of the do not resuscitate or DNR directive. Yet, actual CPR performed on persons with cardiac arrest “almost never works” and when a patient has a DNR order, there exists some confusion about care and risks receiving “sub-optimal care” (Murphy, P., & Price, D., 2007). The ethical dilemmas the medical profession confronts in the interpretations of the DNR order in regards to delivery of duty to care are numerous. Hospitals implement ethics committees to assist in sorting out a patient’s legal rights and ethical issues when physicians, family and patients are at a medical impasse. Ethics committees utilize an unbiased, theoretical approach to inform and assist in the decision-making by using several principles to guide the decision-making process. The principle of Beneficence is to prevent harm, do right unto others and show compassion and non-maleficence, which is avoidance of imposing harm on an individual. The principle of justice is the fairness of treatment in benefits...
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