Do Not Resuscitate

The DWDA contained strict regulations and guidelines governing the usage of PAS. Some of it's main points were as follows. The patient must be able to make a fully informed and voluntary decision based on a terminal diagnosis of less than six months of life by two separate physicians. The patient had to submit two oral and one written request with a waiting period of 15 days between both oral requests and a 48-hour period between the final written request and disbursement of the requested medication. The DWDA did not allow for either mercy killing or active euthanasia, in which the physician performs the act of administering the fatal drug or drugs. The medicines prescribed were either pentobarbital, secobarbital or a combo of amobarbital and secobarbital. It also punishes anyone found to be coercing the patient to use this option.

The recommendation I am suggesting would include a singed “Do Not Resuscitate-DNR” agreement from Margie Whitson. Her legal guardian notified of her request and Hospice be contacted. This would be in leu of a possible health issues that would arise in the future. And with this in place, her wishes can be granted. Margie Whitson has lived a long full filled life and all of her family is deceased. She has come to terms with all the setbacks in her life and now wishes to just stop her suffering.

A physician must understand that when it comes to deciding to withhold or withdraw life sustaining treatment it is ultimately the patient’s decision unless the patient is not competent enough to make this choice. I believe that a person can lose their life at any point. Death is certain and no one can run from it. In my opinion, a patient’s autonomy is of utmost importance anytime during healthcare however the physician can name some recommendations of what would be the best option for the patient. When it comes to patients they deserve to be treated with respect and ultimately be treated as an end not as a means to an end.

Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months.  Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.

In this situation, the doctor asked the husband if he could resuscitate his wife despite her having a DNR. The nurse in the room could have interjected and said that the wife has already signed off on a DNR, and the question of resuscitation is off the table. Also, the nurse could have explained the patient's wishes to the husband and the doctor. In this case, the doctor was influenced by the husband's wants, the husband had told the doctor that he wants his wife to live.

A legal requirement of end of life care is that the wishes of the individual, including whether CPR should be attempted, as well as their wishes how they are cared for after death are properly documented. This means that their rights and wishes even after death are respected.

I believe that the immediate family members should be given the option to be present during resuscitation of the patient. I believe that it is the immediate family members’ right to be present if they

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

I disagree with Dr. Blues assessment and justification for the DNR. Dr. Blue uses the legal term futile incorrectly to back his proposed plan for the patient. The strict definition of futility includes three different categories. The first one is that intervention has no pathophysiological rationale. The second is that Cardiac arrest occurs after refractory progressive hypotension or hypoxemia. Lastly futility can be defined as when intervention has already failed.

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne & Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley & Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, & Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

Confusion in discussions and decision-making about end-of life issues including DNR decision arises from varied perceptions (Kasule, 2012), however DNR policies become a necessity to meet the accreditation standards of acute care hospitals in the USA only from 1988 (Bishop et al, 2010).

Cardiopulmonary resuscitation (CPR) remains a critical situation with high mortality despite improvements in resuscitation procedures and responses(Lin et al., 2010). In Australia and around the world, many patients suffer cardiac arrest but a lot of them do not respond to the conventional cardiopulmonary resuscitation, 5herefore there is a growing interest in using extracorporeal membrane oxygenation (ECMO) or Extracorporeal Membrane Oxygenation assisted cardiopulmonary resuscitation (E-CPR) to provide cardiopulmonary support during in hospital cardiac arrest after conventional cardiopulmonary resuscitation (CPR) has failed to establish an adequate circulation with the goal of promoting survival in select adults (Stub et al., 2015; Thiagarajan

Medications can be used during the defibrillation process. Recent changes to the resuscitation protocols provided by the Australian Resuscitation Council (ARC) recommend that 1 mg of adrenaline be administered through an IV line every 2nd CPR cycle. If the patient has a shockable rhythm such as ventricular fibrillation or pulseless ventricular tachycardia adrenaline is administered after CPR cycles and after the second defibrillation. In the case of “pulseless electrical activity arrest” or “asystolic arrest” the adrenaline needs to be administered immediately. ARC also recommend that Amiodarone can be administered when the cardiac arrest is “routine”. The dose of 300 mg is administered to patients with shockable rhythms such as ventricular

and the frequency and timing of do-not-resuscitate (DNR) designation. The rate of DNR designation was 100% in patients