Without Patient Consent Summary

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.

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

The process of deciding when a terminally ill patient should die lies within the patient, family members, and the

In today's society, one of the most controversial issues is physician-assisted suicide for the terminally ill. Many people feel that it is wrong for people, regardless of their health condition, to ask their health care provider to end their life; while others feel it is their right to be able to choose how and when they die. When a physician is asked to help a patient into death, they have many responsibilities that come along with that single question. Among those responsibilities are: providing valid information as to the terminal illness the patient is suffering, educating the patient as to what their final options may be, making the decision of whether or not to help the patient into death, and also if they do decide to help,

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

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.

In today's society, a very controversial issue is physician-assisted suicide for terminally ill patients. Many people feel that it is wrong for people, regardless of their health situation, to ask their doctor or attendant to end their life. Others feel it is their right to be able to choose how and when they die. When a doctor is asked to help a patient to their death, they have certain responsibilities that come along with it. Among these duties, they must prove valid information as to the terminal illness the patient is suffering. They also must educate the patient as to what their final options may be. When they make the decision of whether or not to help the patient into death, and should they

Critics of PAD have expressed concern about abuse and error in assisted death, but less so about the same margins when it comes to the withdrawal of life-sustaining treatment. They say that there is a clear difference between the act of ending one’s life and simply withdrawal of treatment. (K) However, it is also important to note that this does not mean that those against PAD are for preserving life at all costs, as witnessed by withdrawing care that does no more than prolong suffering. (F) Proponents argue that the act of withdrawing life-sustaining treatment is just as likely to lead to death as a physician giving a lethal dose of a substance, so why are physicians legally required to respect one choice, but not the other? (K) The end result of PAD is comparable to actions that are legally performed by physicians, such as aggressive palliative care, and withdrawal of life-sustaining treatment. (K)

When a patient needs to have a medical procedure performed, they must first consent to the procedure. Before accepting or rejecting the treatment, the practitioner is required to give the patient information pertaining to the risks and benefits of the procedure, as well as available alternatives. Additionally, the patient must be mentally competent enough to make an informed decision, and not be manipulated or coerced into a decision.

It is also clear that while making these decisions, the decisions ought to be made based on informed consent (Werth and Crow 195). Sometime, the patient may be experiencing dementia, clinical depression or delirium for which they may be affecting the patient’s decision making capabilities (Werth and Crow 197, 198). If such a person is allowed to make their right-to-die decision, this may be done without the patient having comprehensive information before consent and thus should not be encouraged (Werth and Crow 198).

In today’s society, suicide, and more controversially, physician assisted suicide, is a hotly debated topic amongst both every day citizens and members of the medical community. The controversial nature of the subject opens up the conversation to scrutinizing the ethics involved. Who can draw the line between morality and immorality on such a delicate subject, between lessening the suffering of a loved one and murder? Is there a moral dissimilarity between letting someone die under your care and killing them? Assuming that PAS suicide is legal under certain circumstances, how stringent need be these circumstances? The patient must be terminally ill to qualify for voluntary physician-assisted suicide, but in the eyes of the non-terminal patients with no physical means to end their life, the ending of their pain through PAS may be worth their death; at what point is the medical staff disregarding a patient’s autonomy? Due to the variability of answers to these questions, the debate over physician-assisted suicide is far from over. However, real life occurrences happen every day outside the realm of debate and rhetoric, and decisions need to be made.

There are many ethical issues involved in the scenario provided. De Segonzac (2016) presented a scenario where a DNR patient is being resuscitated against her wishes. In the scenario, Dr. Natalie Manning is attempting to stop Dr. Will Halstead from going against a patient’s DNR order. He continues to ask the husband if he “wants her to live”, while the daughter is asking her father to help her mother. Dr. Halstead blatantly goes against the patient’s known wishes by performing CPR on her.

A “do not resuscitate” order is a complex, ethical and moral dilemma. From a medical personnel point of view, when his/her patient is put into a situation where death is highly likely or already reached, they will do whatever is necessary to make you survive in that moment. But that doesn’t mean that you will continue to survive long term. Sometimes when a doctor “saves” you in that instance its only for an allotted time, maybe even a couple of hours, sometimes they break your ribs in order to make sure you survive a couple of more

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.

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.