Margaret Johnson
BSHS/332
October 7, 2013
Bradley Leedy

Workplace Ethical Dilemma This paper will present an argument of how the process of do not resuscitate (DNR) results in an ethical dilemma for workers in the healthcare field. In presenting the argument, this paper will also address the following three course learning objectives: 1) explain the legal rights of individuals as they interact with health care services, 2) analyze the monitoring systems that ensure human rights, legal aspects, and quality health care, and 3) analyze selected ethical and legal case studies that have promulgated precedent setting decisions.

Even though the physician may believe CPR would be the appropriate decision, “many a deserving patient loses out on the opportunity for such treatment” as a result of an DNR order (Thomas, 2002, 412). Decisions about resuscitation have become a matter of concern and highly debatable issue because the legality of a patient’s right to request DNR. The order must be approved in advance by a written statements signed by a physician upon order of the patient or surrogate in cases which the patient cannot give consent. A DNR order must not confused with giving care, whereas, do not resuscitate does not mean do not give care. “It means a different kind of care that can best be achieved through end-of-life protocols and education” (Field, 2007, 294).
The process causes ethical dilemmas for health care workers in several ways. For example, in cases which surrogates can give consent to carry out an DNR order; an ethical dilemma may arise in the case which a surrogate may change their mind upon carrying out an DNR order. Surrogates are usually close family members of the patient and may include a spouse, child, parent, or even sibling. A surrogate’s decision on whether or not carry out an DNR should be a decision based upon what the patient would have wanted. However, a surrogate may get caught up in their own emotions; as a result, they may want to make the decision not to carry out the DNR order which may represent their own wishes and not the patient’s. This can present ethical dilemmas for health care workers required to carry out the DNR order, which must be documented. Ethical dilemmas may also arise in DNR cases concerning patients’ and families’ religious beliefs about the DNR process. Some religions do not believe in reviving a patient; therefore a patient or surrogate may order an DNR as result of his or her religious beliefs. This may present ethical dilemmas for health care workers who may believe that CPR is the best choice in some instances; however, health care workers have the moral responsibility to respect the religious beliefs of the patient or surrogate to carry out the DNR order. Ethical dilemma may also arise in cases which a patient may feel his or her right to DNR be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an 88 year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone” (Putnam, 2003, 2025). Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); in this case ethics is questioned because the physician is faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.
There have been many court cases, even some taken as far as the United States Supreme Court, which involved issues such as preserving/prolonging life and DNR. Roberts presents the case Cruzan versus Director of Missouri Health Department. In this case a patient was involved in an automobile accident and was left in a vegetative state. The hospital made the choice to preserve life by inserting a feeding tube; however, the family wanted the feeding tube removed. The case initially made it to the Supreme Court in which Chief Justice Rehnquist prevailed by ruling state could protect the life of patient. A dissenting statement by Justice Brennan, however, a patient should be allowed to die with dignity. (Roberts, 2002, 243-43) This case definitely presents an ethical dilemma the choice was made despite the wishes of the family. In DNR cases, it is important the health care workers understand the importance of their decisions and the legality of the written DNR orders to avoid liability and best carry out the patient’s request in DNR cases (Michael, 2002, 23). Health care workers have the responsibility to know in advance the patient’s directives when it comes to DNR as well as identify related documents (Michael, 2002, 22).
Ethical dilemmas involving carrying out the actual DNR rarely occur in other healthcare areas such as nursing, but mainly occurs with physicians since they are the responsible party for making such decisions and following the DNR orders. However, “once the decision is made, critical care nurses are left with implications of the decision in providing patient and family care” (Prevost, Jensen, & Hodgins, 2000, 259). Yet the use of DNR is justified by two primary rationales: 1) respect for patient autonomy and 2) reduction of futile, costly medical care (Weiss, 2000, 308). Another group of health care workers are Paramedics that may face ethical dilemmas concerning carrying out DNR orders. “Current regulations are a source of conflict between paramedic’s duty to treat and the patient’s right to limit resuscitative efforts at the time of death” (Guru, 1999, 1252). When EMS personnel arrive on the scene of patients’ encountering cardiac arrest, family members are discovering that despite families protesting or even producing documentation, paramedics have chosen to resuscitate and transport individuals to the hospital (Sabatino, 1999, 297). Upon arrival, most, paramedics may not be aware of DNR orders, especially if patients have already experienced cardiac arrest and are in an unconscious state. However, if the paramedics are not aware of the DNR orders they should provide treatment to the fullest extent possible, subject to their level of training, full care, and contact the receiving hospital for further orders.
DNR is a common ethical dilemma that arises in the health care field as patient autonomy is questioned in some cases. Different from earlier years, patients are now participating in healthcare decisions more. “In December, 1991, the Patient Self-Determination Act mandated hospitals to ensure that a patient’s autonomy, that is, their right to make decisions regarding their healthcare, was upheld” (Igoe, 1993, 112A). As a result, health care personnel are faced with the ethical dilemma of their responsibility to carry out the orders and wishes of the patient.

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