Ethic Case Study 74: Ethical Issues Over DNR Rooms

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

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.

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

(TCO D) A patient's family may be actively involved in end-of-life decisions for patients who are incapacitated or incompetent. Compare and contrast two legal cases that address the rights of families in participating in end-of-life decisions. For each legal case, identify how the case either contributed or detracted from the rights of families. (Points : 30)

Thirty-six year old James Foster accompanied by his wife Megan signs his do-not-resuscitate order (DNR). Both Mr. Foster and his wife are understanding of what a do-not-resuscitate order is and are in agreeance. James has stage IV prostate cancer, but he is young and his wife believes he will pull through. A month passes, and early one morning James stops breathing, the patient is coding. Nurse Compton rushes in along with other medical professionals. Mrs. Foster is screaming, “Save him. Save him. Do whatever it takes to save him. Do not let him die.” Nurse Compton knows that Mr. Foster has a do-not-resuscitate order on file and feels not only sad in regards to the situational pain that Mrs. Foster is exhibiting, but morally conflicted with

CNA Code of Ethics for Registered Nurses (2008) provides guidance in dealing with cases like this by explaining the core nursing values and responsibilities involved which are: a) providing safe, compassionate, competent and ethical care; b) promoting health and well-being; c) promoting and respecting informed decision-making, and d) Preserving dignity; e) maintaining confidentiality, f) promoting justice and g) being accountable. The first nursing value is always expected to be upheld in any case because it is their duty to provide care using appropriate safety precautions and preventing/minimizing all forms of violence (CNA, 2008). The collaboration of the nurses between the physician and Mr. C’s family has been evident since then. This therefore calls Mr. C’s nurses to be more compassionate about his situation and try to recognize where he is coming from as they build a trust-worthy relationship before judging him or jumping into conclusions like he does not want to live anymore. Even if he decides to withdraw from these potentially life-sustaining treatments, health care providers are still obliged to give him the care he need the best way they can up until the end of his life. The second nursing value, just like the first one, still calls nurses to still aim to promote or at least maintain Mr. C’s health and well-being to the highest possible level regardless of the path he had chosen for his life. This can be achieved by continuing to collaborate well with other

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

I have specifically identified the three situations above, because I feel only in these cases should the doctor seriously consider the option of PAS, or in the situation of option three, how to alternatively assist a patient who is seriously considering euthanasia. In the first case, I mention the doctor’s patient being in a permanent vegetative state – medically defined as patients who have an irreversible loss of brain damage who are left permanently unaware and extremely unlike to ever recover. The vegetative state case is a vital circumstance in which the doctor should consider euthanasia, because these patients will most likely never function fully as human beings again, therefore never to lead a life worth living. The decision is only to be made by the family, guardian, or caregiver of the patient rather the doctor should end treatment to allow to patient to live. However, this should only be done after six months of complete inactivity of the patient, to secure there is no chance of revival. If the family requests for their loved one to be kept alive after the six month, their wishes must be granted; the doctor shall have no say in the

Individuals who are young and healthy possibly never think about advance directives including a DNR order. Perhaps, it is when a parent or a loved one becomes terminally ill that forces one to look at end of life directives. As a hospital staff nurse, I have found that most people are familiar with the term Do Not Resuscitate (DNR); however, the term advance directives must be further explained to patients and family members. Although terminology can be a barrier, most patients making an end of life decisions have strong opinions concerning the end of life care. Expressing those feelings in legal documentation can be a challenge. The ANA Code of Ethics Provision 1.4 (Nursing Ethics, 2016) addresses the responsibility of the nurse to be knowledgeable

The article “When a Patient Discusses Assisted Dying: Nursing Practice Implication ,” discusses some of the ethical and legal issues regarding patients who are interested in assisted dying . The subject of assisted dying in the media, nationally and internationally, is argued on both sides. Britney Maynard was a patient with incurable brain cancer who blogged about how she moved to Oregon to receive the lethal prescription. The article discusses how patients feel mentally after receiving the news of their terminal illness and how it can lead to depression. Depression can compromise patients’ decision making, especially while being in a hospice setting. Also, patients’ choices can change as they near the end of their lives. Most patients would rather spend their last days at home where they can make their own

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.

In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.

It is important that we act in a way that is ethical, legal, and commendable. Medical professionals struggle with healthcare dilemmas that are not experienced by the general public. Medical-ethical decisions have become increasingly complicated with the advancement of medical science and technology. (Fremgen) Just like the government has laws for citizens, not having laws in healthcare would allow people to do anything they want. It is important that we study the ethics and laws of healthcare, because if we were put in a situation it is essential that we know the difference between right and wrong. In the article I found, it talks about a nurse who refuses to give CPR to an older woman who collapsed in a senior residence where she works. This article has many more ethical issues than legal issues.

The author will analyse scenario 5 (appendix a) as he has no practical experience of Do Not Resuscitate Orders (DNAR) and believes this is an excellent opportunity to professionally develop himself in order to improve future patient care. This assignment will reflect, in relation to paramedic practice, on legal, professional and ethical frameworks whilst also considering interpersonal communication theories that impact on the delivery of care. Legal frameworks, including the Mental Capacity Act (MCA) 2005 and Human Rights Act (HRA) 1997, will be scrutinised alongside professional frameworks offered by the Health and Care Professions Council (HCPC), such as the Standards of conduct, performance and ethics (2012). The impact of these frameworks upon duty of care, consent, capacity and best interests will be examined whilst various interpersonal communication theories will be explored, including transactional analysis and the influence of verbal and non-verbal communication. A conclusion will then be offered with well-supported reasoning for this decision.

The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the