Considering the basic right fostered by DNR – right to one’s autonomy, do you think it is appropriate for a health care provider to render such order despite of their sworn pledges? Please elaborate your answer based on the following sworn pledges. “I solemnly pledge myself before God and in the presence of this assembly… I will abstain from whatever is deleterious and mischievous… devote myself to the welfare of those committed to my care. ” Nightingale’s Pledge “To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them….
…To keep the good of the patient as the highest priority…” Hippocratic Oath 2. DNR, by request, is being practiced predominantly in the western cultures since this is part of the patient’s autonomy. Hence, hospitals and physician consider DNR-by-request despite of the possible interventions that the medical team can render to the patient’s condition. In such case, do you think you are saving the life of an individual by adhering to his right of autonomy? 3. The sworn oath of every health care provider is to provide the utmost care and save lives.
Do you think it is ethical to deliver DNR order with or without available medical options just to satisfy the rights of autonomy and patient’s right to dignified death? If yes, are you not compromising the patient’s rights to life, beneficence, nonmalifecence and utmost care? (There are many rights being compromised by just adhering to the said two rights) 4. Since DNR order negates the use of other apparatus associated to Cardiopulmonary resuscitation, are you not forfeiting or compromising other non-related medical interventions (e. g. surgical operations, etc. ) that can save the patient life?
5. According to Beach and Morrison (2002), DNR order cultivates reluctance of physicians in providing surgical or invasive procedure, do you agree on this study conclusion? If no, then how will you handle a major surgical operation on a DNR patient that will eventually require CPR and other forms of life resuscitation since this is a standard event during major surgery? 6. In terms of dignified death, do you think the patient is dignified whenever a health care provider prevents his/her task from initiating methods (e. g. CPR) that might still save the life of a DNR patient? 7. Are you not defeating the purpose of hospital care if you admit a DNR patient?
(The purpose of the hospital is basically to care, tend to the wounded and save lives) Since a DNR patient will die anyway, why do you think the hospital should admit them considering that the amount of their medical expenses can exceed sky-high just by waiting or dying in a hospital?
8. Considering the study of Watcher, Goldman and Hollander (2005), most patients who ultimately receive DNR orders are competent at the time of admission, but not competent (e. g. experiencing deficits in coherence, under confusion, experiencing severe pain, etc. ) when the DNR order is finally written. Do you think it is still appropriate to consider their DNR request in such condition? If yes, are you not compromising the welfare of your patient by such incompetent decisions, and since not all hospital implement such decision evaluation, do you think it is also ethical to administer such order from an incompetent patient? Conclusion on Con Side of DNR DNR order is thought to be an appropriate palliative measure derived from the ethical principles of autonomy and dignified death.
However, such order provides various disadvantages according to numerous studies, specifically (1) inappropriate decision making of most patients requesting DNR that eventually results to incompetent decision making and eventually compromising the welfare of the patient; (2) essentially limits the possibility of life saving interventions or further alleviations of the condition since DNR-by-request automatically implies the patient’s unwillingness towards medical life-saving interventions; (3) impairs the effectiveness and efficiency of surgical operations if required since surgical operations, especially in major cases, can always trigger events that may need immediate life-saving resuscitation; (4) increased incidence of death among DNR patients regardless of death potentials, and (5) increased health costs due to longer hospital stays, palliative interventions and dying within hospital premises.