describe do- not- resuscitate orders.
withholding and withdrawal of treatment, and
What are some possible controversies with these concepts?
A do-not-resuscitate order (DNR), also known as Do Not Attempt Resuscitation (DNAR), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), no code, or allow natural death, is a medical order, written or oral depending on country, indicating that if a person's heart stops beating, that person should not receive cardiopulmonary resuscitation (CPR). Other crucial or life-prolonging medical measures are sometimes included in these decisions and the paperwork that accompany them. DNR orders have different legal statuses and procedures in different countries. Typically, a physician will issue the order based on a combination of medical judgement and patient participation.
The decision to choose do-not-resuscitate status was based on personal criteria such as health and lifestyle, relational issues (to family or society as a whole), and philosophical factors, according to interviews with patients in Toronto in 2006-9.
In some nations, DNR records are widely available, whereas in others, they are not. In nations where a DNR is not accessible, physicians must make the decision to stop resuscitation on their own.
Some possible controversies:
In several cases, DNR orders have become the subject of ethical discussion. In many hospitals, it is standard practise to have a patient's DNR automatically revoked before surgery. Though the rationale for this is sound, as outcomes from CPR in the operating room are significantly better than general survival outcomes following CPR, the influence on patient autonomy has been a point of contention. Instead of automatically making a forced decision, hospitals should engage patients or their decision makers in a "reconsideration of DNR orders."
When a patient or family and doctors can't agree on a DNR status, it's common to turn to the hospital ethics committee for guidance. However, many members have little or no ethics training, some have little medical training, and they do have conflicts of interest because they work for the same company and budget as the doctors.
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