Leonardo C.

Lintao
BSN 4-1
Situation: An 85 year-old patient is admitted with a large intracerebral hemorrhage, severe neurologic
deficit, and a past medical history of coronary artery bypass graft, hypertension, atrial fibrillation, and
gout. The patient does not have an advance directive. The attending physician suggests a do-not-
resuscitate (DNR) order to the family.
Dilemma: the principle of autonomy for the patient (including death with dignity) conflicts with the
principle of beneficence for the health care providers.
Discussion:
1. What arguments would you pose in favor of the DNR order?
A Do Not Attempt Resuscitation (DNAR) Order, also known as a do not resuscitate (DNR)
order, is written by a licensed physician with consultation and approval of a patient or surrogate
decision maker that indicates whether or not the patient will receive cardiopulmonary resuscitation
(CPR) in the setting of cardiac and/or respiratory arrest, It is valid without an advance directive of
the patient.
Physician possesses proper knowledge and skills about medical diseases and scenario.
According to the scenario the patient is experiencing large intracerebral hemorrhage causing for
severe neurologic deficit and the patient was also undergone coronary artery bypass graft and atrial
fibrillation, in present the patient have hypertension and gout. In the condition of the patient the
physician have an obligation to prevent further complication by weighing and balancing possible
benefits against possible risks of an action which is CPR/Resuscitation. The general rule of
attempting universal CPR needs careful consideration (Blinderman et al., 2012). Even though
including patients and families in decisions regarding resuscitation respects patient autonomy,
providing patients and families with factual information regarding the risks and potential medical
benefit of cardiopulmonary resuscitation is also crucial. Under certain circumstances, CPR may not
offer the patient direct clinical benefit, either because the resuscitation will not be successful or
because surviving the resuscitation will lead to co-morbidities that will merely prolong suffering of
the patient without reversing the underlying disease.
In this case CPR, offers no chance of meaningful medical benefit to the patient.
Interventions can be considered futile or useless if the probability of success is low and if the CPR is
successful, the quality of life is below the minimum acceptable to the patient.
2. What arguments would you pose in against of the DNR order?
 In this case let me use the word Beneficence. According to the code of ethics of health care
provider Beneficence is action that is done for the benefit of patient. Beneficent actions can be
taken to help prevent or remove harms or to simply improve the situation of others. If Cardiac
pulmonary Resuscitation can improve the condition of the patient the physician should give it in
order to preserve life.
If the patient or surrogate decision maker for the patient has refuse to DNR order, even
though they are aware and informed for the possible result of the intervention. The physician
should give resuscitation or other possible interventions to recover the patient no matter what. As
supported by the code ethics which is autonomy for the patient’s body. When we say autonomy it
means that the personal rule of the self that is free from both controlling interferences by others
and from personal limitations that prevent meaningful choice. In this case the patient is
experiencing severe neurologic deficit, so the surrogate decision maker can decide for the patient’s
welfare.
3. Does the family have the right to refuse?
The family of the patient has a right to refuse as long as they meet the following standard by
Washington, it is stated that recognizing a legal hierarchy of surrogate decision-makers, though
generally close family members and significant others should be involved in the discussion and
ideally reach some consensus. Legal guardian should have (1) Individual given durable power of
attorney for health care decisions (2) Spouse of the patient (3) Adult children of patient (all in
agreement) (4) Parents of patient and (5) Adult siblings of patient (all in agreement).

4. Is a DNR order an example of “patient abandonment” by health care workers, or an attempt

to limit treatment and avoid CPR in a patient with an anticipated poor outcome?
It is not an example of patient abandonment but rather giving an alternative option to
prolong the patient life such as care that focuses on the managing symptoms of the patient
which is component of palliative care. Palliative care is caring for a patient focusing in pain
management, emotional and spiritual support to patient and family. When we say
abandonment it is leaving the patient and not giving any kind of treatment and management to
prolong the life of the patient in order word waiting for the patient to die without any treatment
and intervention that is being done. The physician order is just a Do not resuscitate order, but it
does not mean that all pharmacologic and medical treatment should not give the patient. We
can still provide those drugs and intervention that treats and manage their presenting condition.