Physician Orders For Life Sustaining Treatment: A Case Study

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

UHN in Toronto is a major community care network that reaches out to and provides care to the masses. However in order to provide this kind of care they must have a very powerful decision support system. UHN utilizes an advanced CPR to support computerized physician order entry (CPOE). (Wu, Perters, & Morgan, 2002) A CPR system is a computer-based patient record system. A CPR system must provide a comprehensive clinical decision support it must include both a patient focus and a population focus. The physical computer system that is installed on the computers at UHN is called Patient 1® which is a clinical information system developed by Atlanta Based Per-Se

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.

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

The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.

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.

The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's

DNACPR orders are of considerable concern to ambulance staff, the patient and their families in tackling requests at the end of life (NHS End Of Life Care Programme 2007). A study by Stone et al. (2009) showed nearly all participants had questioned whether interventions performed were correct for the patient when using cardiac life support on patients they thought were terminal. When a patient requires resuscitation and a DNACPR is in place immediate sharing of information is critical. At certain points in the patient care pathway incompatible systems may mean DNACPR requests are not being followed and inappropriate resuscitation being attempted.

Charging to 200....Stand clear…Shocking! CPR....EMS providers experience the adrenaline and rush of a patient in cardiac arrest. Trying to bring dead back to life is not a simple task by far, especially with the limitations and resources of the field. But, what happens after the patient makes it to definitive care? Annually, around 300,000 adults in the United States experience out-of-hospital cardiac arrests (AHA), and EMS providers only see the results of the short term survival of the patient, but rarely the actual patient care and recovery after an arrest. Patients undergo intense, aggressive treatment and recovery measures in the hospital post-code. These patients have a variety of treatment regimens

Medical regulators in every province have issued detailed guidelines that doctors must follow to help suffering patients end their lives and most of these guidelines impose safeguards. It is required that at least two doctors must agree that a patient meets the eligibility

The Supreme Court of Canada’s ruling concerning physician-assisted dying in the case of Carter vs. Canada answers the following two questions: 1) Does the current law against physician-assisted dying infringe an individual’s right to life, liberty and security and 2) If the law is a violation of this right, is this violation justified under the Charter of Right’s general limitation clause. The Supreme Court of Canada’s decision on the first question was in the affirmative. The Supreme Court rules that the prohibition of physician assisted dying is void because it deprives a competent adult of assistance when “(1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition

The new operating policy observed by the EMS is fairer than the previous rule in this regard. The previous rule of allocation for Emergency Medical Services gave priority on a first-come first-serve basis for the calls that were demoted to “routine” versus the calls which were not. This meant that no matter the severity of the situation of the patient, whoever was first in line would take priority. This is in contradiction with the “worst-off, sickest first” rule.

Some people think we can have an altered way of not applying the DNR order. Some people think that if a healthcare worker would apply the life- sustaining treatment the patient would have a better chance of fighting the condition or even feel better or happier. A physician is going to look at the goals of the patient and the family or whomever the caregiver is an help them achieve those goals or at least put them in the right direction towards

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.

If my heart were to stop suddenly, I wish to be resuscitated. My serving health care agent may then decide based on medical advice if I am able to exist without life support. If life-support or life sustaining treatments are needed to keep me alive then I request that all those treatments other than those needed to keep me comfortable be discontinued or withheld and that my physician(s) allows me to dies as gently as possible. I understand and authorize this statement as proved by my signature