Do Not Resuscitate Orders – Medical Ethics Example

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"Do Not Resuscitate Orders" is an outstanding example of a paper on medical ethics. A do not resuscitate, DNR refers to an order written by a doctor upon request by a patient instructing health care facilitators not to offer cardiopulmonary resuscitation, CPR, to a patient. A DNR order is only written after consultations between the doctor and the patient or his family. This paper, based on a case, discusses the morality of a nurse granting parents’ wish to end the life of their child when the doctors have instructed do not to resuscitate.

The paper will discuss this issue based on a case study. Dilemma Description Oscar, a 9-year-old boy, was diagnosed with medulloblastoma at the age of one and was treated. At the age of five, all anticancer treatment options had been exhausted while Oscar had developed terminal cancer. Oscar’ s parents knew that their child was going to die. In order to protect their child from unnecessary pain, Oscar’ s parents requested the child’ s doctor to write a DNR order for their child. A DNR order for a child can be written only if the doctor feels that CPR treatment will have no medical benefit to the child. Upon assessing the child, the doctor wrote a DNR as per the parents’ request.

As the nurse in charge of the child, I found the order attached to the child’ s chart. This order was directed to the health care provider who will be in charge of the child. Principles from the Code of Ethics Relation to the Dilemma According to the ANA code of ethics, American nurses are not supposed to participate in active euthanasia. Active euthanasia is described, in this code of ethics, as a case where someone other than the patient takes an action intended to end the life of a patient.

However, the code accepts withholding, withdrawal, or refusal of treatment as ethically acceptable practices within the nursing field. Among the principles that guide nurses in relation to euthanasia is the principle of respect for persons’ autonomy. These people include patients, their families, and colleagues serving in the discipline (ANA, 2014). The codes further advocate that nurses play the role of promoting, preserving, and protecting human life.

This principle asserts that the services of promoting healthcare are extended to all those who require it. However, the codes of ethics’ opposition to nurses taking part in active euthanasia do not limit nurses to take pain-alleviating actions and at times fore-going life-supporting treatments (ANA, 2014). Relating principles from the ANA Code of Ethics to the Dilemma The ANA Code of ethics clearly stipulates the position of the association on euthanasia. The association permits its members, in this case, nurses, to participate in indirect euthanasia. This can involve withdrawing, withholding, or refusing to treat a patient as a way of alleviating pain from them.

A DNR order means that only cardiopulmonary resuscitation will not be done to a patient. This can be interpreted as one way of withdrawing treatment from a patient (Jablonski et al, 2012). When a patient provides a DNR order to a nurse, this does not mean that the nurse stops other forms of treatment. All other forms of treatment that may prolong life are performed with the exception of CPR. These other treatments are more likely to have higher levels of success in a patient than CPR.

In the case study discussed above, Oscar received all other necessary treatments apart from CPR. Chemotherapy was performed to reduce both the spread and effect of cancer on the child.   The code of ethics further stresses the importance of nurses preserving, promoting, and protecting human life but withholding CPR has contrary consequences. This identifies the dilemma, based on the code. However, there should be justifiable reasons when CPR is withheld. One of the cases where a CPR can be withheld is when it is deemed to have no medical benefit.

Additionally, a CPR can be withheld when a patient deemed to be of sound mind clearly indicates that they do not want a CPR to be performed on them (Polit & Beck, 2008). This ensures that a DNR is not used in the wrong way to end life. In Oscar’ s case, CPR would have had no medical benefit considering that he was suffering from terminal cancer. However, if the doctor stated that CPR could benefit the child, a DNR could not have been written. The outcome of the Dilemma Having gone through the ANA code of ethics, I made a decision to implement the DNR order.

Issues, however, rose from some of the child’ s family members who were opposed to the DNR order. They wanted the child to undergo all medical procedures, as the situation would demand. This did not change the situation because the DNR order had been written by a doctor upon the child’ s parents' request and the family could not override it. The expected outcome of the process was to ensure that unnecessary pain was alleviated from the child.

After two weeks, the child’ s heart stopped and CPR was not performed. The child consequently passed away with little pain. Resources available at the Clinic to Assist Dealing with Ethical Dilemmas Among the resources for dealing with ethical dilemmas that were available in the clinic was a work structure that encouraged conversations. The work environment enabled staff to have discussions where everyone felt comfortable to speak up. The environment further provided safety and staffing equipment that helped nurses recover from the process of addressing the patients’ emotional needs. Another resource available was genetic testing technology.

Considering that patients can learn about their genetic profile through online services, the clinic educated nurses on the available technological resources and how they can be used appropriately. When using these resources, nurses had to make sure that they do not cause distress among patients. Additionally, there was an ethics committee in the clinic. This committee was charged with collecting the opinion of nurses concerning the decisions made in the clinic. Conclusion The use of DNR orders in the field of medicine has been an ethical issue for a long time.

The ANA provides ethical principles that guide nurses when dealing with such an incident. Although the association is opposed to active euthanasia, it states that nurses can withdraw or withhold treatment from patients to alleviate suffering. Nurses can therefore implement DNR orders from doctors as long as the orders follow ANA’ s code of ethics.

References

Jablonski, A., Clymin, J., Jacobson, D. & Feldt, K. (2012) The Washington State Death with Dignity Act: A Survey of Nurses Knowledge and Implications for Practice. Journal of Hospice & Palliative Nursing, 14, 45-52

Polit, D. F. & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

American Nurses Association (2014). Code of Ethics for Nurses. Retrieved From http://www.nursingworld.org/codeofethics

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