Sounding board: do-not-resuscitate orders in the operating room

Article Abstract:

In recent decades, more and more patients have become concerned that resuscitation procedures might be used to artificially prolong their lives. As a result, more and more hospitals have implemented do-not-resuscitate (DNR) orders, in which patients may declare their wishes not to be resuscitated if their condition deteriorates. The authors point out some of the ethical considerations that arise if resuscitation becomes necessary in the operating room. On the hospital ward, any condition that would require resuscitation is likely to be due to the patient's illness. If a DNR order is in effect, it must be honored. However, surgery is, by its very nature, life-threatening and of limited duration. Cardiac resuscitation may be required not as a direct result of the patient's illness, but rather as a complication of the surgery. Presumably, patients undergo surgery with the hope of surviving and of enjoying some improvement in their condition. Indeed, if there is no reasonable expectation of improvement, surgery is not justified and should not be performed. Therefore, a DNR order must be considered in the light of the patient's motivation. The authors consider that when resuscitation will help patients reach their treatment goals, it is ethically sound, even if a do-not-resuscitate order is in effect. DNR orders should be temporarily suspended during surgical procedures. However, if the cause of a cardiac arrest during surgery is thought to be a result not of the surgery itself but of the underlying condition, the DNR order should be reinstated. Similarly, if resuscitation would only permit continued deterioration of an irreversible condition, the patient's DNR request should be honored, even during surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Right to refuse treatment, Right to die, Treatment refusal

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Euthanasia and nursing practice - right question, wrong answer

Article Abstract:

A 1996 survey of critical care nurses found that some had given drugs to hasten a patient's death, a practice called euthanasia. However, the questionnaire used by the researcher used terminology that may have been unclear to the nurses. For example, it implied that increasing the dose of morphine could be considered euthanasia. But it could simply be a method of providing increased pain control. Critical care units are characterized by the use of life-sustaining treatments and nurses may be caught between following the doctor's orders and trying to relieve the patient's suffering. The American Nurses Association and the American Association of Critical Care Nurses have published position statements recommending that nurses not participate in euthanasia or assisted suicide.

Practice, Nurses, Euthanasia, Intensive care nursing

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