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Patient autonomy and criminal law
Published in Paweł Daniluk, Patient Autonomy and Criminal Law, 2023
Olga Sovova, Helena Van Beersel Krejčíková
On the other hand, DNR orders seem to be considered, at least to some extent, less problematic if the patients concerned are at the end of their lives. If a patient has been recognised as suffering from an advanced or terminal stage of an incurable disease and has been provided with palliative care, the DNR order has a better chance of being followed.
Neuroethics in Film
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
A do-not-resuscitate (DNR) order is part of a decision that can be put forward in a living will. Many hospitals require that resuscitation orders be addressed upon admission. Families typically request full resuscitative measures upon admission but often ask for a DNR status after seeing no progress in care. DNR status may also come into play when physicians see no improvement despite aggressive measures to reverse the condition, or when there is simply an overwhelmingly bad clinical situation. There is a long history of deescalating the level of care in intensive care units (ICUs).27
Cultural Factors Enriching Palliative Care in the Middle East
Published in Kathleen Benton, Renzo Pegoraro, Finding Dignity at the End of Life, 2020
Azar Naveen Saleem, Azza Adel Hassan
One of the major challenges involved is the do not resuscitate (DNR) decision and discussion. Per Islamic teachings, all mentally competent adults of both genders are granted the full right to accept or refuse medical intervention. In reality, however, close family members often contribute significantly to the decision-making process. Generally, in Muslim families, the parents, spouses, and elder children, in descending order, have greater decision-making power than the rest of the relatives. This applies to DNR discussions also. The palliative care team is expected to have extended family meetings with or without the presence of the patient for treatment decisions (Al-Shahri & Al-Khenaizan, 2005). There are instances where the patient may not be involved in DNR decisions due to family insistence. Due to the lack of developed palliative care, hospice care, and home health services in the region, families of the dying patient prefer to keep the patient in the hospital setting for better medical and nursing care. The concept of euthanasia, which is the intentional ending of life to relieve pain and suffering, is not practiced and is considered prohibited in the region.
Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care?
Published in Acta Clinica Belgica, 2023
Sabine E. E. Lemoyne, Peter Van Bogaert, Paul Calle, Kristien Wouters, Dennis Deblick, Hanne Herbots, Kg. Monsieurs
In Belgium, more than 75% of the NH residents are heavily dependent on care. More than half of them die within 24 months of NH stay [26]. Literature data show that DNR orders with written treatment restrictions often are not available, even for patients with severe life-limiting illness [27–29]. This increases the risk of futile resuscitation as discussed below [30–33]. The NH staff should make the DNR status available for every patient at the time of the EMS intervention [2]. When the NH staff pays more attention to the patient’s wishes regarding medical treatment, less avoidable transfers occur [34,35]. Conversations about advance directives are often perceived as difficult by health-care professionals and many GPs find it hard to identify the ‘right time’ to discuss directives [2]. It is, however, essential for this conversation between the patient and the GP or another treating physician to take place.
A Taxonomy and an Ethicist’s Toolbox: Mapping a Plurality of Normative Approaches
Published in The American Journal of Bioethics, 2019
Sharon L. Feldman, Joseph P. DeMarco, Douglas O. Stewart, Paul J. Ford
The justification for our recommendations will similarly vary depending on the case. In each of the two cases previously outlined, the ethics consultant recommended that a decision be deferred to a surrogate decision-maker. Employing surrogate decision-making on behalf of patients without capacity is what Brummett and Salter would define as a “conventional norms view.” It is an approach supported in scholarly literature, professional practice standards, and law. In this final case, we rely on alternate means of justification. One of the authors (PJF) was consulted by a physician in the medical ICU. The physician was anticipating that a patient’s family would aggressively reject a DNR order. This was a concern because the treating team considered further aggressive measures to be medically inappropriate for this patient, and would no longer offer resuscitation. The physician planned to invite the family to a meeting which she would frame as a forum to decide on whether a DNR order was appropriate. The treating team’s intention was to institute a physician-initiated DNR, even if the family insisted that the patient remain full-code. The ethics consultant clearly expressed that this plan to frame the meeting as a forum to decide was ethically inappropriate. Invoking the sixth of Bernard Gert’s ten moral rules, “Don’t deceive,” (Gert 1988, 157) he explained that it was improper to deceive a patient’s family and that communication should be transparent. In Brummett and Salter’s language, this content-heavy recommendation was justified on a “moral realist” basis.
Advance Care Planning Program and the Knowledge and Attitude Concerning Palliative Care
Published in Clinical Gerontologist, 2019
Huei-Chuan Sung, Shu-Chen Wang, Sheng-Yu Fan, Chia-Ying Lin
Respecting the wishes and preferences of patients with terminally illness is one of the main objectives of palliative care (Davies & Higginson, 2004). The National Comprehensive Cancer Network (NCCN) guidelines suggests that physicians should discuss advance directives with terminally ill patients who have a life expectancy of less than one year (NCCN, 2011). A national survey in the United States revealed that only 26% of physicians discussed end-of-life care when patients could not receive curative treatment, and most physicians would not discuss it when the patients’ condition was still good (Keating et al., 2010). In addition, a large proportion of these discussions between physicians and patients occurred in the hospice wards when the patient was near death (Baile, Lenzi, Parker, Buckman, & Cohen, 2002). In Taiwan, many patients with terminal illness tend to have DNR order but most are signed by their families and near the end of life (Huang, Hu, Chiu, & Chen, 2008; Huang, Huang, & Ko, 2010). A survey in nursing homes in Taiwan showed that 16.4% of residents had advance directives but 91% of them were signed by their families (Lo, Wang, Liu, & Wang, 2010).