Thesis on "Resuscitate (DNR) as a National Healthcare Mandate"

Thesis 8 pages (2548 words) Sources: 6

[EXCERPT] . . . .

Resuscitate (DNR) as a National Healthcare Mandate

Background on DNR

Do not resuscitate (DNR) is a choice that has long been available to patients and families who are faced with end of life (EOL) decisions. It is the choice, usually a patient choice, a personal choice, stipulating the patient's decision not to have healthcare personnel intervene if the patient's heart stops, and, without intervention, will result in the patient's death. It is not suicide. It is, rather, a decision to allow the natural events of life and death processes to unfold without medical or medical technological interventions that would result in reviving the patient and stabilizing the vital life signs that would cause the patient to continue living. As intensely personal as this decision strikes the senses, it is nonetheless a matter of national debate and an issue that is poorly understood by the public at large (Kieman, 2006, p. 257). A national healthcare mandate would eliminate the ambiguity of DNR as it now exists, and would resolve the question of whether or not a healthcare entity and healthcare personnel should act to revive a patient whose heart stops beating.

Sociologist and author, Stephen Kieman (2006), in his book, Last Rights: Rescuing the End of Life from the Medical System, argues:

"The need for leadership on end-of-life care is long overdue. True, a few members of Congress are loyal allies of hospice. But hearings like those that shaped the 1970s over access to dialysis, when that treatment was new, simply have not occurred. The voice with national reach that can articulate end-of-life issues in the political realm have thus far been silent (p. 257)."

Kieman goes on to discuss the inadequately prepared medical students who emerge from having completed successful career training with little or no training in caring for terminally ill and end-of-life patients (p. 257). We might add to that idea nursing students who, if their training is not specific to hospice care, are likewise inadequately prepared in end-of-life care giving and who are poorly prepared to respond to the needs of end-of-life patients. Perhaps Colm Kieman (1973) cast light on the issue more succinctly when he wrote: "Ultimately the choice is between a mystery of faith or a debate without end (p. 224)." A national mandate would bring an end to the debate.

Recently, as a result of the public's lack of information and understanding on EOL choices and DNR, the issue of DNR has come once again into the national spotlight. President Obama was, as has been widely publicized, forced to weigh in on the issue of DNR, because the public responded to his proposed legislation for a national healthcare plan with allegations and concerns that such legislation would include termination of life. DNR is not about terminating life, but since the issue came into focus, President Obama has voiced his support for a national conversation on the subject of EOL care in a New York Times Magazine interview (Leonhardt, 2009, found online). While the recent attention brought to bear on the subject of EOL has once again emphasized the need for a national mandate on the subject, Obama's proposed legislation that brought it back to the public's attention is not the first time the public has reacted strongly to this very personal and emotional issue.

Turning Points in EOL Debate

The first modern turning point for EOL decision making came in 1990, when national attention cast the spotlight on the subject in the actions and person of Dr. Jack Kervorkian, a retired pathologist from Michigan (Dubler and Nimmons, 1993, p. 169). Kervorkian became nationally known, and debated, after retiring when he began engaging in what became known as assisted suicides. Kervorkian assisted disabled and terminally ill people in ending their lives, avoiding direct suicide, which might have been in conflict with their religious beliefs. Kervorkian did an end run around the law that would have otherwise found him guilty of murder by creating a machine that served to eliminate him as the source of the person's death, and the person as the hand that took his or her own life.

Kervorkian did eventually spend time in jail for his actions, but not until he had assisted numerous individuals and their families in terminating what were otherwise painful and tortuous lives of physical affliction (although the measurement of the individual's pain and the nature of the afflictions from which he relieved individuals from continues to be debated in medical and legal arenas).

The legality of what Kervorkian did is not what is at issue here. Rather, it is the fact that patients who found their lives to be intolerable because of pain and disease could not legally or medically choose to end their lives from that suffering. Kervorkian brought to national attention the lack of control individuals have over their own life choices when the quality of life is diminished to but a painful existence, and often bed-ridden one and one which depends on modern medical technology to sustain life, but whose condition defies the legal criteria for removing life supporting technology, and pre-empts the patient's family from making that decision, but, instead, leaves the decision to sustain life to the medical practitioners. All of this would perhaps be easier for the public to accept but for the fact that there is a lack of consistency in how the medical community responds to situations on a case-by-case basis in the literature. Add to this formula the response of the far right religious conservatives, and there emerges a clear and concise need for a national mandate on the issue of EOL choices and whose choice it is.

The need for the national mandate, and one to eliminate the influence of public opinion, is perhaps most clearly demonstrated by the case of a young woman whose quality of life, and the very nature and definition of the word life, and the decision to end or artificially sustain it, became a national debate that brought even Congress to a momentary halt in national affairs in debate the matter. The woman, Terri Schiavo, whose case had been in and out of the national media for years, came into the national attention once again, and this time with fierce debate that involved the public, Congress, and even the office of the President of the United States.

Schiavo was a young Florida resident whose life came to an abrupt standstill in 1990 after she suffered a heart (Walter and Shannon, p. 269). After suffering a prolonged period of loss of oxygen to her brain, Schiavo remained in a persistent vegetative state (p. 269). Ten years later, when Schiavo's husband petitioned to have the feeding tubes that were sustaining his wife's life removed, there erupted a battle between Schiavo's husband and her parents that soon drew in lawyers, medical doctors, the media, the public, and the United States Congress into a discussion over the definition of life, death, and the right to choose, and whose right, in the case where a patient cannot make that decision for his or her self, it then becomes to make the choice on behalf of the patient. Schiavo's case brought opinions from every sector of America to bear on public policy concerning the right to choose death over life support, and created a public arena around what most people would prefer to remain a private and personal issue in their own lives.

Finally, on March 18, 2005, against the wishes of Schiavo's parents, the courts found in favor of Schiavo's husband, and the feeding tubes that provided the vital sustenance to Schiavo's body to sustain life were removed (p. 269). Schiavo died on March 31, 2005, having remained in a vegetative state while her body was deprived of the nutritional sustenance that would have prolonged her life (p. 270). The debate that grew around the issue of removing Schiavo's feeding tube brought about changes in the Catholic Church's position on life and death, and, today, for a Catholic to choose to remove the feeding tubes in a case such as Schiavo's, would be committing a sin (p. 270).

This is why the public is closely watching any debate or action to be taken on the issue of DNR. Choosing not to intervene in the dying process, to prevent it happening, has become contrary to the American public's perception of life, and that life should be sustained, and efforts to prevent death should be taken at all costs. DNR usurps the public's rights over the individual's rights, and give the individual the right to choose.

DNR as a National Mandate

The order for a DNR by which medical personnel are guided in their efforts to attempt to revive a patient, or not to attempt that effort, should be part of a national mandate that outlines the following:

Policy

1. When a life prolonging medical intervention is withdrawn and the expected outcome is death no CPR will be initiated

2. When the patient exhibits signs and symptoms… READ MORE

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