In cases of cardiac or respiratory arrest, doctors, nurses, and other healthcare professionals conduct resuscitation, which is a medical procedure meant to restore cardiac function in such cases (The Cleveland Clinic Department of Bioethics, 2005). DNR, or “do not resuscitate” is an order that prohibits resuscitation to individuals who gave the order (The Cleveland Clinic Department of Bioethics, 2005). DNR orders are often executed by patients, whether in a hospital or nursing home (NYS Department of Health).
Wherever a patient may be, the DNR order prohibits medical practitioners from performing cardiopulmonary resuscitation or CPR to attempt to restore the heartbeat and breathing of a patient whose heart has stopped beating (NYS Department of Health). Similar to a DNR order is a DNI order, or a “do not intubate” order. This is a separate order because essentially, resuscitation is different from intubation (WebMD, Inc. , 2007).
Intubation involves the insertion of a tube through the nose or mouth to into the trachea so that the patient can breathe (WebMD, Inc. 2007). Intubation could prevent respiratory arrest or heart attack (Caring Connections & National Alliance for Hispanic Health). A person’s need for either intubation or resuscitation may differ depending on the circumstances, and it is possible that a person gets difficulty breathing even though his heart functions well (WebMD, Inc. , 2007). Thus, a DNR order does not always include a DNI order, and vice versa. All adults can execute or ask for a DNR order (NYS Department of Health).
In certain instances, family members, friends, or representatives may also execute the DNR in behalf of the patient (NYS Department of Health). The main consideration for having a DNR ready is the fear or possibility of the failure of CPR or intubation (NYS Department of Health). The success or failure of CPR or intubation depends on many factors, including the general state of health and age of the patient (NYS Department of Health). Less healthy and ageing patients may have other conditions and frailties that could hinder the success of CPR or intubation (NYS Department of Health).
Cardiac arrest can sometimes signal the shutting down process of the body, and CPR or intubation could only serve to interrupt such natural process (Caring Connections & National Alliance for Hispanic Health). Therefore, a failed resuscitation or intubation could lead to worse cases, such as brain damage (NYS Department of Health), dependency on a ventilator, or broken bones from the compression of the chest (Caring Connections & National Alliance for Hispanic Health).
Thus, patients, particularly the older ones, prefer to die in relative peace rather than undergo aggressive resuscitation or intubation procedures. DNR/DNI orders are widely accepted as ethical practice (NYS Department of Health). Thus, healthcare professionals are mandated to respect such orders and refrain from giving treatment even though they feel CPR or intubation could still save the patient’s life.
Thus, healthcare professionals, nurses, and doctors are left with few options when they face the dilemma between honoring a DNR/DNI order or his medical instinct (NYS Department of Health). First, he must follow the DNR/DNI order. Second, if he cannot follow the order, he must transfer the patient’s care to another doctor who would do so. Lastly, he could try to settle the dispute the soonest possible time (NYS Department of Health). There are many ethical issues relating to the execution of DNR/DNI orders.
Working in acute health care setting as a nurse, this issue is an ever-present one that needs resolution. Ethical issues on this aspect revolve around the question of the right or authority to decide whether to discontinue life or prolong it. The justifications for the favorable ethical standing of DNR/DNI orders lie in the medical possibilities that are present in the given circumstances. Given the above-discussed considerations relating to health and old age, there are medical cases where CPR or intubation becomes an unwise option.
The possibility of a fate worse than death, such as permanent brain damage, may not be worth pursuing, and the case might just be nature’s way of ending a person’s life (NYS Department of Health). Another justification for DNR/DNI orders from the ethical standpoint is freedom of choice. Pursuant to Kantian philosophy that gives premium on human reason and free will, the ultimate choice and control over a person’s life lies in himself alone, except in certain cases where he is no longer equipped with the necessary faculties to make such decisions on his own.
Nursing care is directly involved with the ethical issues on this respect because they are the ones who are often faced with the dilemma between honoring a patient’s DNR/DNI order or following the medically justified path. Given the existing laws and rules on the matter, nurses can do nothing but follow protocol, and respect such orders when present. Ultimately, the law and the rules do not place the decision in their hands, but on the patient’s.