The health care industry changes more dramatically and more often than any other business (Sultz & Young, 2010). One of the most dramatic changes that affect every patient is the extraordinary ability and implementation of life saving measures. Even when there is no brain activity at all, patients can be kept alive on respirators that breathe oxygen in and out of their bodies. When a patient’s heart has stopped beating, a defibrillator can be used to jolt their heart back alive and beating again. Even though a life saving measure of one kind or another is capable of being utilized, there are some patients that do not wish to have anything done; they do not want to be brought back to life. As with any end of life decision, there are ethical issues that need to be addressed in order to fully and ethically complete a do-not- resuscitate order.
A do-not-resuscitate order is one that is “given by a physician indicating that in the event of a cardiac or respiratory arrest “no” resuscitative measures should be used to revive the patient” (Pozgar & Santucci, 2010, pg. 132). The physician can write the do-not-resuscitate order at the request of the family, appointed caregiver, or from information obtained from an advanced directive (Pozgar & Santucci, 2010). Originally, the history of the do-not-resuscitate order stems from the case of Cruzan v. Director, Missouri dept. of Health, 497 U.S. 261, 110 S. Ct. 28411 (1990); the outcome of the case was that is it “recognized that a competent person had a constitutionally protected liberty interest in refusing unwanted medical treatment” (Pozgar & Santucci, 2010, pg. 121). If a patient does not want to be resuscitated after cardiac arrest, then they have the right to choose to die. These orders are most commonly used in advanced stages of disease, elderly patients, or when a physician feels that life saving measures would not benefit the patient and only do more harm than good (Pozgar & Santucci, 2010). Since the case of Cruzan v. Director, Missouri dept. of Health, a competent person can make the decision to create a do- not- resuscitate order in the event of cardiac arrest in an advanced directive. A physician can come to the family with the option of a do-not-resuscitate order, but it can only be written with the express consent of the patient; if the patient is unable to make the decision then a surrogate is appointed.
The Patient Self-Determination Act of 1990 was “enacted to ensure that patients are informed of their rights to execute advance directive and accept or refuse medical care” (Pozgar & Santucci, 2010, pg. 53). Facilities that participate in the Medicare program are required to allow their patients to execute advance directives (Pozgar & Santucci, 2010). Facilities ask patients on admittance to the hospital if they have an advanced directive. If the patient does not have one, then they are asked if they would like information on how to get one. This Act was the beginning of a new information era for patients. As noted in Pozgar & Santucci (2010) The Patient Self-Determination Act of 1990 provides that:
Providers are required to provide individuals written information concerning their rights under state law to make decisions including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives, document the individual’s medical record whether the individual has executed an advance directive, not condition the provision of care or otherwise discriminate against an individual based on whether the individual has executed an advance directive, ensure compliance with requirements of State law regarding advance directives, provide education for staff concerning its policies and procedures on advance directives, provide for community education regarding issues concerning advance directives by defining what constitutes an advance directive, emphasizing that an advance directive...
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