DNR Order: the Case Against Cardiopulmonary Resuscitation

DNR order is written in conjunction with a patient or surrogate decision-maker by a licensed physician specifying whether or not the patient may undergo cardiopulmonary resuscitation (CPR) in cardiac and/or respiratory arrest. CPR is a series of various medical treatments that aim to preserve vital organ perfusion while trying to reverse the underlying cause of heart failure.

The history of instructions for CPR and DNR is thoroughly discussed in the literature. In the 1960s, CPR was initially performed by cardiologists on adults and children who had experienced cardiac arrest following reversible illnesses and injuries. Based on the success of this intervention, CPR has become the standard of care for all cardiorespiratory etiologies.

CPR became the norm of treatment for all etiologies of respiratory failure on the grounds of the efficacy of this technique and the widespread presumptive consent to resuscitation developed. The American Heart Association (AHA) noted in 1974, however, that several patients who received CPR survived substantial morbidities and recommended that physicians record in the graph when CPR is not indicated after obtaining a patient. The DNR order officially became known as this documentati Modern medical research recommends this documentation to be referred to as do-not-resuscitation (DNR) and requires natural death and based on the realistic fact that CPR is an attempt to save lives rather than a promise of survival..

Since the initial beginning of the DNR orders, respect for the rights of adult patients and their surrogates to make medical decisions, better known as respect for autonomy or respect for individuals, has been stressed. This principle is constitutionally strengthened in the 1991 Patient Self Determination Act, which mandates hospitals to recognize the right of elderly patients to establish an Advanced Care Directive. Generally, the focus on strengthening contact with patients and relatives is favored over doctors making unilateral decisions based on claims of medical futility regarding the resuscitation condition of their patients.

Last but not least, for certain cases, patients are unable to engage in the decision-making process and thus cannot communicate their desires for cardiopulmonary resuscitation. In these cases, two methods are used to ensure that the best effort is made to provide the patient with the medical services they would need if they could articulate their voice.These approaches include Advance Treatment Planning and the use of alternative decision-makers. Not all individuals have Advance Treatment Plans. In these cases, a proxy decision-maker who is close to the patient and is familiar with the desires of the patient may be found.

07 July 2022
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