Do Not Resuscitate

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Do Not Resuscitate

Antonea Johnson

Chamberlain University School of Nursing

Professor Laura Jacobus

Date: Week 5 11/28/2021

Annotated Bibliography

Yuen, J. K., Reid, M. C., & Fetters, M. D. (2011). Hospital do-not-resuscitate orders: why they have failed and how to fix them. Journal of general internal medicine, 26(7), 791-797.

In the article, Yuen, Reid, and Fetters (2011) discuss how do-not-resuscitate (DNR) orders have failed and various ways they can be fixed to ensure better patient and doctor engagements. The authors contend that DNR orders have been used for several years but have failed to fulfill their purpose as required. The article talks of the satisfaction of “informed consent” (p. 792) which entails the patients position of making informed decisions for their treatment. Similarly, it also looks at the total volume and rewards of “intensity of care” (p. 795) which entails overtreatment of patients with severe and life-limiting conditions which in the end do not offer better or improved outcomes. The issues raised by the authors include the neglecting, delaying, and offering inadequate DNR discussions by practitioners, including the inappropriate extrapolating of such orders. I agree with the sentiments echoed by the authors, and this is because physicians often delay information leading to poor decisions by patients. The article is crucial and has helped me understand the various factors that make DNR ineffective in the hospital setting. Changes in “inadequate hospital policies” (793) can be a good start to bring about positive and workable DNR orders.

Weissman, D. E. (1999). Do not resuscitate orders: a call for reform. Journal of palliative medicine, 2(2), 149-152.

The viewpoint by Weissman (1999) digs more profound on the issues surrounding palliative care, and more specifically, DNR orders. It is an area that has been under debate and discussions because of its weighty nature and most importantly its nature as a policy for every hospital. However, within this discourse, cancer patients are considered, with their pain, the discussion is centered on the reasons for DNR orders. The main concepts include “patient autonomy” (p. 242), which implies the decisions made by patients without their caregivers’ influence. Similarly, issues of “policy reforms” (p. 243) are discussed. These centers on the need for physicians to keep most information with themselves in regard to CPR or “unilateral DNR orders” (p. 243) which means that a patient desires to continue with treatment. At the same time, the medical professionals see no need for continued support regarding medical provisions. I agree with the sentiments of Weissman because within this time or period, patients are in their end period of life, and issues of DNR orders make little sense ethically. I will make use of “modern medical ethics” in the final research paper to understand vital principles that underpin DNR orders. This work is crucial as it has brought about a new dimension regarding patients at the end stage of their life and issues that deal with DNR orders.

Cook, I., Kirkup, A. L., Langham, L. J., Malik, M. A., Marlow, G., & Sammy, I. (2017). End of life care and do not resuscitate orders: how much does age influence decision making? A systematic review and meta-analysis. Gerontology and geriatric medicine, 3, 2333721417713422.

In the journal, Cook et al. (2017) demystifies the issue of attempting resuscitation during a cardiac arrest and whether the use of age represents “ageism” (p. 7). This is the discrimination of people in relation to their age. Also, the paper discusses “Resuscitation decision” (p. 10) which entails the decisions made by both patients and their caregivers when considering the patients’ age. I agree with the authors because research has proven that age does increase with the use of do not resuscitate orders; however, there is a need for more research to link this to ageism. The work by the authors was crucial in understanding the relationship that exists between patients’ age and DNR orders. “Ageism” (p. 7) will be an essential factor to consider in the final paper, and this will help determine how age determines DNR orders irrespective of the nature of the illness. From the review, it was clear that age is a vital determinant when dealing with DNR orders and specifically when dealing with critically ill patients. It has brought new levels of understanding in line with patients’ quality of life and career preferences, including their probability of survival.

Sultan, H., Mansour, R., Shamieh, O., Al-Tabba, A., & Al-Hussaini, M. (2021). DNR and COVID-19: The Ethical Dilemma and Suggested Solutions. Frontiers in Public Health, 9.

The report by Sultan et al. (2021) offers information about “ethics, and ethical dilemmas” (p. 4), and these are the most basic aptitude in the healthcare sector. Therefore, for purposes of handling the dilemmas in times that are hard more so during the Covid 19 period or when making DNR decisions, environments are required to be blame-free. In the process of making DNR decisions, especially when dealing with settings of “poor prognosis” (p. 3), ethical dilemmas come into play for the healthcare providers, patients, and their family members. A case in point, and which is under discussion, is when one has contacted Covid-19. Poor prognosis, in this case, relates to minimal chances of getting better or recovery. The authors are right because balancing a patient’s equity vs. equality and beneficence vs. autonomy is a challenge and a big concern for practitioners. Difficult decisions are always made during such periods, and usually, society benefits prevail to those of individuals. To this end, the “consequences of Hippocratic Oath” (p. 3) will come in handy as this will help understand the basis of making tough decisions. The report is critical and opens up more information about the rights and obligations of both patients and their caregivers.

Cantor, M. D., Braddock III, C. H., Derse, A. R., Edwards, D. M., Logue, G. L., Nelson, W., ... & Fox, E. (2003). Do-not-resuscitate orders and medical futility. Archives of Internal Medicine, 163(22), 2689-2694.

In their report, Cantor et al. (2003) discuss issues pertaining to difficult situations where patients desire CPR even when physicians are fully convinced that this will be futile. The authors critically look at DNR orders, including “medical futility” (p. 2690), and the different legal, ethical and medical issues involved with recommendations to easily resolve the prevailing challenges. Medical futility in this case means that the therapy that has been proposed should not be performed. This is because with the available data, the patient's medical condition will not improve. The patient’s “medical considerations” (p. 2690) are also used to define the level of futility. In this case, the considerations refer to the likelihood of succeeding with the CPR, albeit the conditions of the patient in question. The authors contend that the different conflicts surrounding “DNR orders including medical futility” (p. 2693) should not be resolved by way of a reform or policy but a fair process which looks into particular cases, and this will be a crucial addition to the final research paper. I agree with the sentiments made by the authors because currently, physicians are barred from entering an order over a patient’s objection even when issues of medical futility are at play. The report provides better legal and medical considerations that should be used when dealing with DNR orders.

Rachels, J., & Rachels, S. (2019). The elements of moral philosophy (9th ed). Philadelphia: McGraw-Hill Education.

Rachels J and Rachels S (2019), in their book The Elements of Moral Philosophy, discuss more on absolute moral rules and Immanuel Kant’s moral theory. It discusses “The Categorical Imperative” (p. 128), which is a crucial idea denoting that defending the notion that rules have no exception is a complex undertaking. “Kant’s Arguments on Lying” (p. 130) depicts issues that inform people that behaviors ought to be guided by universal laws, and these are moral laws that hold true to individuals’ circumstances. It also discusses issues of “humanity as special and unique” (p. 145) under Kant’s core ideas and this implies that they are not only different but better when compared to other creatures. I agree with the authors' sentiments because humans are different and often guided by set laws that help them make decisions. The final paper will employ the model “humanity as special and unique” (p. 145) to indicate that each person is different. The book is vital and has helped in understanding the uniqueness of man in relation to their behaviors and the set rules and guidelines.

References

Rachels, J., & Rachels, S. (2019). The elements of moral philosophy (9th ed). Philadelphia: McGraw-Hill Education.

Sultan, H., Mansour, R., Shamieh, O., Al-Tabba, A., & Al-Hussaini, M. (2021). DNR and COVID-19: The Ethical Dilemma and Suggested Solutions. Frontiers in Public Health, 9.

Weissman, D. E. (1999). Do not resuscitate orders: a call for reform. Journal of palliative medicine, 2(2), 149-152.

Yuen, J. K., Reid, M. C., & Fetters, M. D. (2011). Hospital do-not-resuscitate orders: why they have failed and how to fix them. Journal of general internal medicine, 26(7), 791-797.