Legislating Medical Ethics: A Study of the New York State Do-Not-Resuscitate Law (Philosophy and Med

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This position is grounded in the idea that disputes over whether a treatment is warranted are in part disputes about the relative values of the individuals involved. In many cases, to do so appears morally indefensible because it makes an erroneous epistemological claim that medical expertise leads to a similar expertise in assessing the merit of individual values. How should a best interests or futility assessment be made in relation to a decision to implement a DNR order? I have suggested that neither the values of the patient, doctor, nor the community can be given individual primacy in grounding such decisions.

The decision has to be made, however, and it is the treating doctor who is ultimately charged with making it. I propose that doctors ought to derive a balanced best interests assessment in relation to DNR orders by incorporating their own views with those of the patient if competent in the context of prevailing community values. If doctor and patient are in dispute about whether a DNR order should be implemented then patients should have access to due process to resolve the dispute.

I acknowledge that the notion of doctors incorporating community values into a best interests assessment presents difficulties.

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How are such values to be identified? Moreover, if the community values that influence the nature of medical goals represent erroneous perceptions of what is achievable then such values as a force driving the direction of medicine might be seriously questioned. Television medical drama represents one possible source of such misperceptions. One study looked at the rate of recovery from cardiac arrest on TV programmes as compared to in life and found a dramatic improvement in survival odds for the television patients.

Education programmes could incorporate discussion of the nature and prognosis of CPR and the reality of the intensive care unit experience, perhaps allowing patients to make more realistic appraisals of the benefit to them of resuscitation at the end of life. They might also allow doctors to appreciate that some patients may benefit from treatment that the doctors themselves believed was futile.

Such programmes could also provide a forum for community groups to feed back their concerns to the medical profession. How might a fair process be implemented in the hospital setting to resolve treatment disputes at the end of life? The Council on Ethical and Judicial Affairs of the American Medical Association proposes an algorithmic approach to disagreement which involves deliberation between patients, their proxies, the treating consultant and an ethics committee, with the option of transfer to another institution if agreement cannot be reached. It is acknowledged that legal action may ensue if the latter course is chosen.

Such an approach represents a compromise that recognises the value laden nature of futility assessments and attempts to ameliorate the potential unfairness of these assessments by appealing to a broader based set of values. Consider the example of an 80 year old man with metastatic lung cancer admitted to hospital with increasing shortness of breath and a diagnosis of pneumonia. On admission the patient refuses to consent to a DNR order and expresses the wish for intubation and ventilation in the event of cardiopulmonary arrest. A fair process would focus initially on enhancing communication between doctor and patient in an attempt to achieve a concordance of values.

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The experience of Murphy suggests that such an approach can be effective. If the second clinician concurred with the views of the first a next step might be to involve a clinical ethicist as mediator. If disagreement persisted then a hospital regulatory body, perhaps a patient ethics committee which included lay representation, could convene to arbitrate the dispute. Clearly, this type of review would be untenable where a patient faces imminent death and there is no time to set the process in train.

I do not believe so. Such an approach ought not to be seen as persecutory but simply an extension of a system where any decision a doctor takes is open to retrospective review to determine its probity. Physicians may be concerned that the preceding discussion indicates that all disputed care plans for patients need to go through a process of arbitration and that a physician is never justified in rejecting any requested treatments, no matter how absurd, out of hand. I would like to address these concerns by proposing three standards that physicians might adopt as guidance for when third party scrutiny should be sought for decisions to withhold therapies in the face of patient dissent.

I propose that a review process should be triggered when one or more of the following conditions obtain:. The first standard recognises the importance of both patient and community values in the best interests assessment. The second standard recognises the gravity of decisions to withhold potentially life-prolonging therapies.

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The preceding discussion has, I hope, substantiated several points. This argument is grounded in the notion that the consent process exists to protect patient autonomy and prevent harm. Assessments of treatment futility at the end of life have strong parallels with assessments of best interests. The significance of the value judgments implicit in assessments of futility cannot be determined without patient input. This observation strongly challenges the idea that a unilateral futility assessment could have validity and implies an obligation on the part of health care professionals to inform patients of therapies that they plan to withhold.

Neither respect for physician autonomy, physician integrity, nor the concept of therapeutic privilege constitute justifiable reasons for making unilateral futility judgments. If the patient dissents to treatment being withheld then initial attempts at resolving the conflict should focus on efforts at enhanced communication.

Failure to resolve conflict with these measures should trigger a fair process approach to dispute resolution. Recognition that physicians should be empowered to make certain value judgments to withhold therapies without the need for third party review leads to the proposal of three standards. It is suggested that doctors ought to seek third party review of decisions to withhold treatment in the face of patient dissent when: All DNR orders will relate to withholding treatment that conforms to the third standard and many will proscribe treatment that conforms to the other two standards.

The corollary of this observation is that patient dissent to a DNR order ought not to be overridden by an individual physician.

Effectively, this means patient consent is required to write a DNR order. It is my view, however, that implied, rather than express consent should be the requisite standard. That is, if a competent patient is informed that a treatment is to be withheld and does not dissent then implied consent ought to be allowed to be assumed. This specification stems from reports of distress occurring among elderly patients required to sign consent forms to the withholding of life prolonging therapy.

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Do Not Resuscitate: An Argumentative Essay

Set up a giveaway. There's a problem loading this menu right now. Get fast, free shipping with Amazon Prime. Your recently viewed items and featured recommendations. View or edit your browsing history. Get to Know Us. English Choose a language for shopping. Amazon Music Stream millions of songs. Decisional authority to use or withhold CPR must reside in providers who can use their training, skills and knowledge to provide the best available care [ 2 ]. Irrespective of international variation in decision-making, the DNR decisions form part of an essential framework to uninterrupted the dignified death by a futile resuscitation attempt [ 9 ].

In Judaism patients who are terminally ill may be withhold or refused the CPR. Because it may prolonging the dying process and may increase suffering and pain for Jewish patients. Halachic authorities recommend a family to consult with their rabbi in situations involving the consideration of a DNR order [ 17 ]. In Catholic patients who are terminally ill permitted to withhold or refuse life-sustaining treatment like CPR if its judged to be extraordinary by the patient and family, and should always be respected and complied with that decision, unless it is contrary to Catholic moral teaching [ 21 ].

Finally, the DNR decision is a sophisticated bioethical discussion, although, the DNR orders have a wide cultural differences in their implementation. Taking in consideration according to King Hussein Cancer Center statistic that caring cancer patients on mechanical ventilator whose medically futile cost the center about JD daily, so many organization start to talk about DNR and introduce it to community to be familiar with this term and to differentiate between DNR and assist suicide.

The purpose of this literature review was to summarize the different ethical and legal aspects regarding the DNR code status which developed along the time according to different cultures including values, beliefs, and religious background. In this paper the researcher illustrated his agreement position from the DNR order supported by ethical and legal aspects. The current researcher is with DNR code status because some people at the end of life continuing of suffer may appear worse than death.

Watching a dying patient suffers can be nearly intolerable for loved ones. The DNR order does not mean patient will die alone and uncared, it means patient will be placed under hospice care when the end is near, and will not die with a tube in any site of body. The CPR might also seem to lack benefit when the patient's quality of life is so poor that no meaningful survival is expected even if CPR were successful at restoring circulatory stability.

To that end, the current researcher strives to assist the individual in taking decision in terminally ill and hopeless cases to use the DNR order.

The DNR still consider a difficult and extraneous concept, in spite of health care providers' efforts to help patients and families to make informed choices. The life of human being in Islam is sacred and wealthy and nobody on earth can end it, so; there is a value and great respect to human life and the exciting civil forbids euthanasia or assisted suicide, in regards to other issues like brain death and DNR, the verdicts of the Islamic been facilitating easy courses medical futility prescribed by specialist doctors.

So, the DNR order is permissible in cases of a high degree of certainty that resuscitation is not feasible and will not lead to a net and lasting benefit to the patients permanently. Focusing on survival after CPR among patients with cancer according to Ehlenbach et al. Accordingly, the current researcher with DNR order because the patients' chances of surviving until discharge could not be improved by CPR.

Although, there are many risks involved in performing CPR, including the decrease level of consciousness and chronic coma which sometimes is worse than death, or survival after CPR then death occurring after a long time stay in the intensive care unit. For that choice is clear between deaths on the oncology ward, surrounded by loved family members, nurses and doctors who knew the patient or death in the intensive care unit after multiple attempt of invasive, painful, and dehumanizing procedures but if the patient's heart stopped to work, the family heart will stop at the same.

In order to protect the autonomy right of the patient to make health care decisions, certain measures need to be taken to ensure that the potential harm to patients is minimized, in addition legislate law to protect DNR policy and procedure is essential, also, the ethics committee needs to be involved more in such situations. The current researcher articulates the following fundamental principles to guide action on the DNR issue:. Discussion DNR with patients and family might be taken in consider for the following patients: Discussion of DNR with patients and family should be included all treatment modalities and balancing between risks and benefits of each treatment.

Although, changing the word from DNR to allow natural death, this concept is more descriptive, have more acceptance and sometimes less threatening. In health care organizations, the current researcher advocates to have clear DNR policies in place and communicate it to nurses enable them to effectively participate in this crucial aspect of patient care and to be aware and have an active role in developing this policy.

The appropriate use of DNR orders, with adequate palliative and end of life care, can minimize the suffering for many dying patients who developed cardiac arrest. There is a different ethical and legal aspect between opponents and proponents from the DNR order. The purpose of this paper was to discuss the DNR order among different cultures in cases of medical futile and patients refuse treatment to summarize the different opinions from the legal and ethical perspective.

And current researcher is with applying DNR. The Fatwa states that if three knowledgeable and trustworthy physicians agree that the patient condition is hopeless; the life-supporting machines can be withdrawn or withheld. The family members' opinion is not included in decision-making as they are unqualified to make such decision. One reason to choose DNR status that because the patient is suffering and it is better because they have less sufferance.

Unfortunately when the loved patients have the opportunity to decide if they want DNR, the family should respect their decision. If they are choosing DNR is because they are suffering a lot illnesses like cancer, which is very painful and traumatic, and when there is no cure for them it is better to practice not to extend their suffering. The author thinks DNR is the patient's choice and relatives should respect this decision.

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