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DNR Orders and Ethics in Medical Decision-Making

Introduction

It is important to note that DNR orders are critical decisions made by patients and their relatives. There are many potential reasons why DNR orders are requested, which might involve an incurable condition or worsened quality of life post-resuscitation. The demonstrated case is unique because the cause of respiratory failure is due to oxygen supply mismanagement rather than the patient’s own health deterioration. Although the situation is intricate, the therapist needs to adhere to the DNR order on the basis of deontology, utilitarianism, and core ethical principles.

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The Patient’s Directives, Quality of Life, and Family Preferences

The patient’s directives were clearly evidenced by the fact that he requested a DNR order should he require it. The patient’s quality of life was affected by his age and chronic obstructive pulmonary disease. In the case of family preferences, it should be noted the patient’s wife also requested the DNR order alongside the husband. In other words, there was no conflicting input on the DNR order, and there were major indicators of promising quality of life improvements.

The Cause of the Patient’s Current Respiratory Distress

The primary cause of respiratory failure was the mismanagement of oxygen supply. Prior to the latter incident, the patient was recovering from his upper respiratory tract infection due to oxygen, fluids, and antibiotics. It is possible that his age and chronic obstructive pulmonary disease made him highly susceptible to complications from such infections. However, the direct cause of the respiratory failure was an inadvertent turn-up in the oxygen supply.

The Moral Issues Associated with Limiting Life Support

There are a number of moral issues associated with the notion of intentionally limiting life support. A DNR order is a form of such limitation, where patients refuse to be resuscitated when they might require it. However, it should be noted that “a DNR order does not mean “do not treat.” Rather, it means only that CPR will not be attempted. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided” (Sabatino, 2021, para. 3). In other words, a DNR order does not imply anything except a refusal to receive CPR, which is why it does not reflect a patient’s will to live or other reasons. Someone might request a DNR order for a wide range of reasons unknown to the medical staff, and thus, the adherence to avoid providing CPR must be respected and upheld.

Therefore, the moral dilemma in the given case is not about the DNR order specifically but rather the oxygen mismanagement. Morality addresses the differentiation between what is right or wrong and good or evil. Oxygen mismanagement was wrong, and the direct cause needs to be determined, but adherence to the DNR order, even under such a condition, is right because the patient and his wife requested it. Even if the CRP is provided to the patient, his quality of life might be severely worsened after the procedure, which is wrong.

The Ethical Principles Most Relevant to Reaching an Ethically Sound Decision

DNR orders create a major ethical dilemma when it comes to the core principles of medical decision-making. The four fundamental ethical principles in medicine include autonomy, non-maleficence, beneficence, and justice (Pettersson et al., 2018, p. 2). The first principle refers to the obligation to respect a patient’s right to choose, refuse, and agree to treatment. The second one mandates that a professional medical needs act in a patient’s best interest. Non-maleficence obliges a doctor or nurse not to cause harm, whereas justice is about equal and fair distribution of scarce resources. The given case is a conflict between autonomy and non-maleficence because the cause of respiratory failure is oxygen mismanagement. In other words, the medical facility caused harm to a patient in terms of oxygen supply turn up, but the patient used his autonomy to refuse CPR.

In order to make a sound ethical decision, ethical perspectives need to be applied to the case, such as utilitarianism, virtue ethics, and deontology. In accordance with virtue ethics, it is the virtuousness of a person which determines whether or not the action is right (Pettersson et al., 2018). In other words, under the given perspective, a virtuous medical professional’s action of providing or not providing CPR will both be good. Therefore, virtue ethics has little to no relevance to the case. However, utilitarianism prioritizes the consequences of one’s actions, where the desired outcome is the maximization of the good and the minimization of the bad (Pettersson et al., 2018). In the given case, non-provision of CPR will result in the death of the patient, whereas the provision of the procedure has a risk of low quality of life. A study suggests that “quality of life for survivors of cardiac arrest and cardiopulmonary resuscitation was generally acceptable. However, studies also described survivors’ experience of anxiety, depression, post-traumatic stress, and cognitive dysfunction” (Haydon et al., 2016, p. 6). In other words, there is no clear guarantee that the patient’s quality of life will be satisfactory after the procedure, and considering his age and chronic condition, it is up to the medical expert to decide.

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The third ethical perspective is deontology, which focuses on the notion of duty and rights. According to the given framework, ethicality is determined not by consequences or actors but by actions themselves (Pettersson et al., 2018). A DNR order implies duty for a medical professional and represents a patient’s right to choose his or her treatment. Therefore, the patient must not be given CPR because it is a duty of a medical expert to respect the autonomy of the patient.

Conclusion

In conclusion, virtue ethics did not provide a conclusive insight, whereas utilitarianism is difficult to apply without knowing the potential quality of life implications on the patient. The core ethical principles show that maleficence was done to the patient, and the current decision is about his autonomy. However, only deontology offers a clear decision on the case, which adheres to the DNR order.

References

Haydon, G., van der Riet, P., & Maguire, J. (2016). Survivors’ quality of life after cardiopulmonary resuscitation: An integrative review of the literature. Scandinavian Journal of Caring Sciences, 31(1), 6–26. Web.

Pettersson, M., Hedström, M., & Höglund, A. T. (2018). Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care. BMC Medical Ethics, 19(63), 1-12. Web.

Sabatino, C. (2021). Do-Not-Resuscitate (DNR) orders. MSD Manual. Web.

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StudyCorgi. (2022) 'DNR Orders and Ethics in Medical Decision-Making'. 3 December.

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