Antonea Johnson Antonea Johnson Week 3 Assignment: Course Project Milestone – Topic

Antonea Johnson
Antonea Johnson
Week 3 Assignment: Course Project Milestone – Topic Selection and Discussion
Week 3 Assignment: Course Project Milestone – Topic Selection and Discussion
Do Not Rescucitate Order
Do Not Rescucitate Order
Today I want to focus on DNR ethical dilemmas in healthcare. What is a DNR Order? A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. What is CPR? CPR involves: Simple efforts such as mouth-to-mouth breathing and pressing on the chest with chest compressions. Electric shock also is used to restart the heart. Breathing tubes to open the airway and medicines can be used as well to bring someone back to life.
If you are near the end of your life, you are able to decide whether or not if you want to receive CPR or not. It’s best to make the decision while you can. If this decision is left up to your loved ones then it can become a hard decision because most loved ones do not want to give up on their loved one. I believe it’s best to consult with your physician about the pros and cons of having a DNR order. If you choose to have a do-not-resuscitate order, tell your physician and healthcare team so that the proper steps can happen. The doctor usually makes sure that their is proper documentation in your records so that all medical personnel knows and honor/respect your wishes.
What would an ethical egoist say about an DNR order? “On their view, known as Ethical Egoism, each person ought to pursue his or her own self interest exclusively.” (Rachels, 2019). Ethical Egoism is considered to be the morality of selfishness. So when we think of implementing a DNR order as an ethical egoist we make the selfish decision of believing that our loved ones can live without us, no matter how they feel about our decision. Ethical Egoism focuses truly on the way things “should be”.
“Ethical Egoism does not forbid such actions; in fact it recommends them.” (Rachels, 2019). This theory insists on what makes things right but the act is right because it benefits you. In regards to DNR orders, this decision should most definitely be left up to each individual. Although, we know that our loved ones would decline the order, we make decisions based of what we believe is best for oneself.
The Social Contract Theory explains the purpose of both morality and government. “Morality consists in the set of rules, governing behavior, that rational people will accept, on the condition that others accept them as well. When it comes to a social contract ethicist and do-not-resuscitate orders; many family members don’t understand.
This is problematic because family members are frequently unfamiliar with the procedures involved in CPR, lack accurate information about patients’ prognoses, and routinely overestimate patients’ preferences for CPR and other life-sustaining treatments.
“Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes — to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure.” (Yuen, J, Carrington Reid, M, & Fetters, M 2011). These failures lead to consequences.
A social contract ethicist would say that there is not enough information being given out in order for patient families to understand why the patient may have chosen a DNR order. If families don’t feel like they can gain from their loved one being brought back or CPR, then I’m sure they would feel like the physician, nurses, and hospital staff has failed them.
With families not being properly notified of when their loved one has signed a DNR order, or they just don’t have any knowledge of their family members diagnosis, or wishes, then this creates problems not only for the family but for the patient as well. When I say create problems I simply mean that they are going against what a ethical egoist and / or what the patient wants to happen. I would have to say that maybe a DNR order should be discussed when a patient first enters the hospital for admission. Also, I think that DNR orders should also be discussed at the physician offices when a patient becomes a new patient or when a patient decides to establish care with a new provider as well.
Families can also receive more information on DNR orders by taking the time to accompany their loved one to doctors appointments and hospital visits. Although, we are in the middle of a pandemic currently it has to be some kind of way that DNR can be discussed frequently to make sure that their aren’t any issues with declining the patients wishes and also the family can be at peace with the decision on why the patient chose to sign a DNR order.
According to the nursing code of ethics, it states that patients should be able to make independent decisions. This means that everything must be explained to patients in detail so that they are able and willing to make a decision if required based on their medical care and the education that the nurse will provide. Nurses cannot influence patients on making decisions. Patients must be able to make their own decisions when it comes to their health.
Examples of this in the code of nursing ethics is: “obtaining informed consent from the patient for treatment, accepting the situation when a patient refuses a medication, and maintaining confidentiality. Nurses are the main hospital personnel that patients come into contact with while in care. Nurses usually have the mentality of I have to do whatever it takes to take care of the patients.
I totally agree with the nursing code of ethics, in that I believe each patient encounter will be different and we must so whatever it takes to fulfill the needs of the patient, even if it means that we maintain confidentiality from the family about a patient DNR order. Nurses are the advocate for patients in some situations that arises, especially when it comes to notifying families to respect the family members wishes, although sometimes it’s not considered to be the best/ right decision.
In conclusion, I believe that no matter what we must do the morally correct thing when it comes to a patient signing or requesting a do-not-resuscitate order. We must respect the wishes of the individual no matter if we know the outcome or end result maybe different. We can do this together by allowing the family to receive more information on DNR orders ahead of time, if possible. In emergency situations, there may not be anytime to discus DNR orders or the patients wishes. However, I believe that in emergency situations you are asked the ultimate question when you first arrive at the hospital for treatment, as well as when you see a physician to establish care. Physicians usually know when to discuss in detail with patients about DNR orders.
References:
Rachels, J., & Rachels, S. (2019) The Elements of Moral Philosophy. (4th ed.). McGraw-Hill Education.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138592/
https://medlineplus.gov/ency/patientinstructions/000473.htm
https://www.snhu.edu/about-us/newsroom/health/ethics-in-nursing