How DNR Causes an Ethical Dilemma
HCA 322, Health Care Ethics and Medical Law
Dr. David Cole
January 22, 2010
Abstract This paper will present an argument of how the process of do not resuscitate (DNR) results in an ethical dilemma for workers in the healthcare field. In presenting the argument, this paper will also address the following three course learning objectives: 1) explain the legal rights of individuals as they interact with health care services, 2) analyze the monitoring systems that ensure human rights, legal aspects, and quality health care, and 3) analyze selected ethical and legal case studies that have promulgated precedent setting decisions.
How DNR Causes and Ethical Dilemma Ethical dilemmas occur in healthcare when healthcare workers have to choose from among two or more acceptable courses of action or having to choose between equally unacceptable alternatives. Healthcare workers are often placed in the position of having to incorporate their own moral reasoning in order to resolve ethical dilemmas. Advances in medical technology and treatment have allowed healthcare workers to be able to artificially prolong and preserve life. However, patients may put healthcare workers at risk of ethical dilemma by refusing care or treatment, even though these patients have the right to do so. A popular legal issue that places healthcare workers at risk of ethical dilemma is the process of do not resuscitate or DNR. “A do-not-resuscitate (DNR) order is a written medical order that documents a patient’s wishes regarding resuscitation and, more specifically, the patient’s desire to avoid cardiopulmonary resuscitation “CPR”. (Payne & Thornlow, 2008, 11). DNR is one of the most important patient directives due to the fact that it has irreversible consequences. (Payne & Thornlow, 2008, 11) Even though the physician may feel CPR would be the appropriate decision, “many a deserving patient loses out on the opportunity for such treatment” as a result of a DNR order. (Thomas, 2002, 412) Decisions about resuscitation have become a matter of concern and highly debatable issue due to the legality of a patient’s right to request DNR. A DNR order must be approved in advance by a written statements signed by a physician upon order of the patient or surrogate in cases where the patient cannot give consent. A DNR order must not be confused with giving care, whereas, do not resuscitate does not mean do not give care. “It means a different kind of care that can best be achieved through end-of-life protocols and education.” (Field, 2007, 294) The DNR process causes ethical dilemmas for healthcare workers in several different ways. For example, in cases where surrogates can give consent to carry out a DNR order; an ethical dilemma may arise in the case where a surrogate may change their mind upon carrying out a DNR order. Surrogates are usually close family members of the patient and may include a spouse, child, parent, or even sibling. A surrogate’s decision on whether or not carry out a DNR should be a decision based upon what the patient would have wanted. However, a surrogate may get caught up in their own emotions; as a result, they may want to make the decision to not carry out the DNR order which may represent their own wishes and not the patient’s. This can present ethical dilemmas for healthcare workers who are required to carry out the DNR order which must be documented. Ethical dilemmas may also arise in DNR cases when it comes to patients’ and families’ religious beliefs about the DNR process. Some religious do not believe in reviving a patient; therefore a patient or surrogate may order a DNR as result of their religious beliefs. This may...