Some years ago I was working on a project in a hospital. While working with the charts, every now and then I would see these letters “DNR” printed boldly in black on the first page. At that time I did not know what this abbreviation meant and did not ask. Seeing this abbreviation again in Chapter 3 reading brought that back to me.
DO NOT RESUSCITATE. This is a directive from medical staff saying basically do not try to give CPR if the patient’s heart or breathing stops. The book states that this is considered “medically appropriate and morally permissible” under some conditions (seriously or terminally ill). Also, a patient can personally set these orders in place via verbal notice or living will.
The point I am addressing is what seems to be the AMA's (American Medical Association) strong paternalistic stance concerning DNR protocols. “The physician has an ethical obligation to honor the resuscitation preference expressed by the patient. Physicians should not permit their personal value judgments about quality of life to obstruct the implementation of a patient’s preferences regarding the use of CPR.”
I thought it interesting that the AMA was addressing this issue in very strong language. The organization seems to be directing physicians to give patient consent priority over any of the personal, moral or medical objections doctors may have. This only addresses the organization’s side of the issue. Though I am not trying to be cynical, I do believe this statement has more legal rather than moral implications.
Below are two recent legal cases about DNR orders. The first is when a hospital (UK) initiated them without the patient’s consent. This has two ethical issues involved. The paternalist move concerning the DNR status and the moral issue of not involving the patient's family in the decision making. The other is quite different. While the hospital initiated the DNR again, it was done over the protest of the infant's mother. There are other legal issues that make this very complex. the other is patient’s fighting to have DNR status lifted.
The first ruling reiterates the priority of patients’ rights and informed consents in DNR cases. The second is an unresolved but is looking a parent’s right to override a hospital’s DNR decision.
I think the hospital has the right to override the mother's decision in this case because it says that the baby has no functioning due to neurological damage and seems to be in pain. I realize the the mother would be devastated if she lost her baby, but the baby would suffer for the rest of whatever short life it has left. In addition to that, the article said that the mother has barely visited the baby while it has been taken from her custody. It is better in these situations to just let the suffering patient let go. Also, it is a more difficult decision if the patient has come to the conclusion on their own that the do not wish to be resuscitated, even if they have a chance of living. Legally they are obligate to respect the wish, but doctor's pledge to do no harm and save lives at any cost. If there were no chance of recovery, I think it would be more appropriate, but why should they waste a life if it's not necessary?
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