Term Paper on "Do Not Resuscitate and Right to Die?"

Term Paper 5 pages (1879 words) Sources: 1+

[EXCERPT] . . . .

DNR

Do-Not-Resuscitate and Right to Die

There are many controversial issues that members of the healthcare community must face on a daily basis. One major issue is the policies associated with do-not-resuscitate and "Right to Die" expectations. This is because there are many associated legal concerns, accounting concerns and ethics. At a time when the current healthcare climate throughout the United States entails an aging population, far too many uninsured citizens and extremely high operating costs coupled with a scarcity in many key areas, especially nursing, it is vital that the nursing field build caches of new professionals with solid educational foundations. The do-not-resuscitate and "Right to Die" area of patient care can therefore be considered to be an important aspect and can often be a direct link to a nurse's morale. A happy an well informed nurse is important because, "studies have tried to elicit and predict reasons for high staff turnover in order to limit cost and adverse effects on morale, enthusiasm and organizational reputation." (Joshua-Amadi)

Therefore, how do-not-resuscitate or "Right to Die" situations are handled on the floor and throughout facilities can either be seen as logical approaches to dealing with patient's specific conditions and requests or a patient's, a healthcare administrator's, a doctor's or a nurse's worst nightmare. The problem is that the current need for the superior understanding of do-not-resuscitate and "Right to Die" issues, policies and procedures comes at a time when the entire healthcare industry can be considered to be reeling from HMO and other entities that have systematically created cost control measures. One can not forget that patient's and their families' expectations are also higher then ever. "Sometimes patient satisfaction needs to be measured one patient at a time. This usually has nothing to do with the impersonality of the plan, the aloofness of the provider, or the quality of the specialists to whom one is referred. Rather, it involves the basic rationing philosophies of HMOs, particularly the for-profit variety." (Birenbaum, 107)

From the perspective of the nursing community, it will obviously continue to be very important that the profession meets and exceeds the expectations of the community, consumers and the healthcare industry itself. One way to do this can be done is to have nurse to patient relationships with fewer issues and concerns. How then should a controversial topic such as do-not-resuscitate and "Right to Die" issues with patients be handled?

Arguments for Nurses have a unique perspective of the healthcare experience. When a patient is slowly dying of kidney disease or has terminal cancer, nurses must understand that a plethora of patients may rather choose to end it all, to go peacefully in as pain free a manner as possible as opposed to receiving unwanted and continuous medical care. Life may no longer (and will never again be) a pleasant experience for some patients. This implies that those patients may decide that they do not want electric shocks or breathing tubes if and when their hearts or lungs fail. The patient simply has to make those facts known to the medical community via do-not-resuscitate or "Right to Die" documentation. Soon after, the specific facility and that patient's medical chart simply need to be properly updated and the order must be carried out by all involved in the care process. This approach to healthcare has many major advantages.

Consider that the United States healthcare system includes many health plans, physicians, hospitals, clinics, consumers, and public health programs. These entities are all usually focused on life and health recovery. But, the healthcare community also incorporates a very large hospice aspect which is utilized by both insured and uninsured patients that are terminally ill. As our nation's median age of the overall population steadily rises, more Americans will need the services provided by hospice organizations - or, they should be allowed to choose the option of do-not-resuscitate or "Right to Die" as valid approaches to end stage life. Once patients are to a point where they can be assured that there are no possibilities and/or options left for curing their fatal disease for example, allowing the end to come more naturally may actually be more humane. This approach relieves many burdens such as when a financial burden is inadvertently put on the surviving family if life is extended artificially. And this also applies to the associated costs for the healthcare community where do-not-resuscitate or "Right to Die" approaches may be ideal in regard to cost maintenance.

The medical community has created an excellent reputation for dealing with the pressures related to the care of terminally-ill patients and those in the final stages of life often foresee an empty shell of a body being maintained by machines. Human beings simply have their own view on what entails the best quality of life possible as well as what it is to be comfortable and pain free. And, patients also have their own notions as to what costs can be justified and what is too expensive. Healthcare facilities such as free clinics, hospitals and nursing homes all maintain a level of understanding when it comes to justifying life giving services when there is no one to pay the bill -- do-not-resuscitate and "Right to Die" orders can and do save many cost related issues.

Arguments against One major area against the concepts and associated notions of do-not-resuscitate and "Right to Die" orders are the confluence of professional opinions and the various jurisdictions of the topic. Consider that do-not-resuscitate and "Right to Die" orders combine several grey areas for professionals in the spectrums of medicine, law, and ethics. Each of these areas may hold differing opinions on the implementation, legality and legitamcy of the do-not-resuscitate and "Right to Die" orders.

For example, the majority of the healthcare community, including doctors and nursing professionals, usually consider do-not-resuscitate and "Right to Die" orders as binding agreements between the patient and the healthcare community. Therefore, these orders are usually followed to the letter by medical professionals. However, within the legal community as well as the ethical and philosophical parts of the spectrum, there may often be a great many questions and debates as to the very foundation and legality of the healthcare communities' existing practices. Even when there are do-not-resuscitate and "Right to Die" orders or other specific end life instructions, there may still be levels of interpretation. Consider for example when a do-not-resuscitate or "Right to Die" order is in place but a new cure comes along for a terminal patient. Even basics of language come into play as defining do-not-resuscitate and "Right to Die" in one case may mean something completely different in another case such as using dialysis or morphine as a medical option.

Thus, a nursing professional may technically be breaking the law or may be ethically crossing a line that he or she may either believe in or be totally against. When a nurse or medical professional is in the process of following a patient's request of a do-not-resuscitate or "Right to Die" order, there may be too many underlying situations involved. This legal and ethical uncertainty can put a medical professional such as a nurse into a precarious situation and may even give rise to levels of second guessing.

This is based on the concerns regarding inherent or potential disciplinary actions, malpractice liability possibilities and even criminal prosecution. With these types of concerns, it may not come as a surprise that even some very experienced nurses have demonstrated a reluctance to enforce some medically appropriate do-not-resuscitate or "Right to Die" orders. This reluctance could and does create areas of concern where nursing professionals may demonstrate forced levels of indecisiveness. That can create additional patient suffering and even the misapplication of medical resources. Thus, it is often the case that even with do-not-resuscitate or "Right to Die" orders, patients choice of care is still controlled by the very facilities that house the do-not-resuscitate orders.

Other areas of concern against do-not-resuscitate or "Right to Die" orders from the perspective of the nursing profession is the vagary of the applicable laws. Since 1988, "the Joint Commission on Accreditation of Health Care Organizations (JCAHO) mandates that all hospitals develop formal policies regarding the writing of do-not-resuscitate orders." (Joint Commission on the Accreditation of Healthcare Organizations) Existing laws do give patient's the right to accept or refuse treatment; yet, those same laws often do not encompass the legal rights of those performing the care. Consider that the Patient Self-Determination Act, for example, does not mandate a specific protocol but instead creates a policy that care facilities simply formulate their own written policies on advance directives and provide this information to patients upon admission. Although this philosophy does provide a higher level of patient educational value and incentives for hospitals to educate their staffs on the proper implementation of do-not-resuscitate and "Right to Die" orders, it is far from a universal policy and does not offer a true blanket of legal protection for the medical professionals.

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