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Dna Do Not Res

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Running Head: DNA

Do Not Resuscitate
Kimberly Johnson-Lockett
HCA322: Health Care Ethics & Medical Law

Instructor: Eugene Elliott

March 4, 2014

Do Not Resuscitate (DNR) orders are medical directives to withhold efforts to revive a patient who has a cardiac or respiratory arrest (Lee, M. B., M.D. 2012). DNR laws started in the late 70s because of the extensive practice of cardiopulmonary resuscitation (CPR). An unending discussion about DNR has involved the level to which patients or their surrogate have to make the decision to agree to such orders. Throughout the late 70’s and early 80s, a lot hospitals normally made DNR orders that did not including an discussion with the patient or the patient's family. Also, a lot hospitals did not clearly document the DNR order in the patient's chart. This practices were forsaken as the bioethics drive and the courts stressed the right of patients or their surrogate decision makers to decline medical treatment. This also including life insufficient treatment for example CPR. Most of health care providers, health professional groups and indorsing bodies started to support DNR policies. The DNR policies require that the patient be informed of the risks and benefits of CPR and to give consent that CPR not be used. (Lee, M. B., M.D. 2012) DNR is reflect one of the ethical dilemma in current society that came from medical development, ethical dilemmas arise in the area of health care when health care providers is in a position to choose between two or more harmful option, and a lot of time the physician are forced to deal with their value to solve ethical dilemmas. Most of health care professionals encourage DNR and try to negotiate and discuss other views built on ethical principles, they want to show consideration of autonomy, beneficence, non- maleficence, fair and justice. Also sadly these ethical values are directed to be with or not in favor for DNR depend on situation. (Lee, M.D. 2012) I will present the different views about DNR, the disagreement and counter argument, also focusing on ethical laws in order to defend human rights, and right to die or to live. Furthermore the value of autonomy, persons Do Not Resuscitate, integrity, respect and human dignity should be considered in defending the authors’ claim of agreeing DNR orders and patients wills (Torke 2011). According to Michigan State “The purpose of this policy is to provide a guideline to prehospital providers, who under certain circumstances may accommodate patients who do not wish to receive and/or may not benefit from cardiopulmonary resuscitation. This policy is drafted in accordance with Public Act 368 of 1978, as amended, as well as Act 192 and 193 of the Public Acts of 1996. This policy is intended to facilitate kind, humane, and compassionate service for patients who have executed a valid “Do-not-resuscitate order” under the aforementioned Acts (Michigan State)” DNR different from an advance directive and healthcare power of attorney, a DNR order is not a document that everyone needs. You can make DNR order before you go to the hospital if you do not want CPR or other unexpected measures that will be used on you if you collapse at home. CPR have and can save lives, but the achievement rates are not high. If the patients are seriously ill, CPR has make things worse; it can leave the patient painful injuries or brain-damaged. According to research “For one physician’s view on the ineffectiveness of CPR on patients who are old or ill typically, people consider a DNR if they have a terminal illness or are at a high risk for cardiac or respiratory arrest. In the words of the Texas law authorizing DNR orders, the document serves allow a person “to forgo resuscitation attempts and … have a natural death with peace and dignity” (Tork 2011). A pre-hospital DNR direction is usually an easy, one-page document; the patient will not need a lawyer to prepare it. Patient do need to talk to their physician, who will wittiness your signature on the DNR. In a lot states, you just need an adult witnesses or a notary public must also observe the patient sign the order. A lot of states have their own forms; and others, have the patient to just written it out. Their physician should be able to deliver the paperwork. Patient can find that a lot of states have the DNR forms online at the state health department’s website.

The patient should follow whatever laws or rules that their state enforces. If you look at Florida their DNR form have to be printed out on yellow paper. If it is not on the yellow paper it is not valid and the emergency medical department do not have to honor it. If the patient move to another state or spend considerable time there, you will need to get a DNR order that conforms with that state law (Sanderson 2013). A pre-hospital DNR order would not have any result if the emergency medical staff does not see it before they begin CPR. If patient have a DNR order they should save a copy in a noticeable place for example on the refrigerator, by your bedside, where emergency staff could look for medication lists. The patient should keep one in their purse or wallet, when patient is traveling, it should be a copy in their suitcase also they should make sure whoever they are with knows where it is. Another idea is to buy a bracelets to alert emergency medical staff that you have a DNR (Sanderson 2013). According to Children Hospital in Detroit “A patient may present to the Emergency Department with a non-institutional DNR order form. Michigan laws allows a patient to execute a DNR order in a non-institutional setting. The patient should have an identification bracelet on their wrist imprinted with the words DO NOT RESUSCITATE ORDER (Children Hospital 2010)”. While Michigan law does not grant immunity regarding compliance with a non-institutional DNR order in an institutional setting such as a hospital/operating unit, the existence of a non-institutional DNR order form and identification bracelet is evidence of the patient’s wishes. (Children Hospital 2010) A lot states now have another form, this form is called” Physician Orders for Life-Sustaining Treatment” (POLST), which is a separate pieces of a DNR and an advance directive (AD). Within a POLST, you can say your wishes about DNR and speak on the treatment issues as well. Patient can find out more about these forms if they look on your states website that they live in.
The DNR is only one of its kind in the health care that is the single decision that has to be made previously before the incident has occurred. Without a DNR decision by the patient and the physician, all medical staff are obligatory to start CPR when the patient’s heart stop even if it is clear that this is not the best choice. Consequently, the DNR decision must be pass on to at least to the staff. (Sanderson 2013) A lot people consider DNR standard based on physicians and nurses position in decrease the suffering and uphold self-respect for terminally ill patients. This depends on the patient’s morals and treatment targets; there a lot of intervention man made hydration and nutrition, defibrillation, ventilation, pace making devices, pressers, etc. can be acceptable for a time, while acute resuscitation may not use because CPR are usually produces poor results and intensify suffering. Illness and death from CPR for patients with never- ending illness are very high, while other shapes of intervention, though still risky, can ensure a better likelihood for reaching their planned outcomes (Tork 2011). DNR is the way that must be on the patient and the family can reduce the long and painful period of non-desirable benefit of treatment, also “DNR” is the way in which patient and family could reduce the long and painful time before he/she dies (Tork 2011). Based on a Michigan law passed in 1990, the “Designation of a Patient Advocate” is legally binding and is sometimes called a “Durable Power of Attorney for Health Care.” Don’t confuse the term “Durable Power of Attorney for Health Care” with the term “Durable Power of Attorney,” which relates to decisions about your financial matters. Your Patient Advocate named in your Advance Directive for Health Care cannot make any decisions about your finances, unless you choose that same person to make financial decisions on your behalf in a separate legal document. This booklet and the enclosed legal documents do not address your finances or who will have the ability to make decisions related to your money. (Children’s Hospital 2013)
In conclusion DNR policies should require that the patient understand the problems and the benefits of CPR and too give consent not to use CPR. The patient need to talk with the doctor to understand the do and don’t if they sign a DNR.

Reference
Children Hospital of Detroit, MI Retrieved on March 4, 2014 from http://www.dmc.org/
Flegel, Ken,M.D.C.M., M.Sc, & Fletcher, John, MB,B.Chir, M.P.H. (2012). Choosing when and how to die: Are we ready to perform therapeutic homicide? Canadian Medical Association.Journal, 184(11), 1227. Retrieved from http://search.proquest.com/docview/1034107107?accountid=32521
Lee, M. B., M.D. (2012). Honoring the patient and the family: When the family refuses DNR. Care Management Journals, 13(2), 63-6. Retrieved from http://search.proquest.com/docview/1020993754?accountid=32521
Michigan Government Retrieved on March 3, 2014 from http://michigan.gov/documents/mdch/Do_not_resuscitate.policy_298357_7.pdf
Sanderson, A., M.D., Zurakowski, D., PhD., & Wolfe, Joanne,M.D., M.P.H. (2013). Clinician perspectives regarding the do-not-resuscitate order. Archives of Pediatrics & Adolescent Medicine, 167(10), 954. Retrieved from http://search.proquest.com/docview/1442583194?accountid=32521
Torke, A. M., Sachs, G. A., Helft, P. R., Petronio, S., Purnell, C., Hui, S., & Callahan, C. M. (2011). Timing of do-not-resuscitate orders for hospitalized older adults who require a surrogate decision-maker. Journal of the American Geriatrics Society, 59(7), 1326-1331. doi:http://dx.doi.org/10.1111/j.1532-5415.2011.03480.x

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