A Do Not Resuscitate (DNR) Order is one of the contentious issues in ethical and legal provisions within healthcare settings of palliative care. Federal and state laws guide the application of such DNR statutes but also conflict with the ethical values and principles of healthcare professionals and society in general. Indeed, there are many cases where patients have been given the cases of DNR orders, and such orders execution has raised mixed reactions creating conflict between law and ethical values. An exemplary scenario involves the case of a 70-year-old patient with a history of chronic obstructive pulmonary diseases, diabetes mellitus, and atrial fibrillation with a tattoo of DNR on his chest. The physicians interpreted the tattoo and followed it, failing to provide medical care of resuscitation to that patient. It is a decision that is wrong. Had I been on that hospital’s ethics committee, I would have advised that they ought not to have honored the tattoo, and their advisement was morally unsound even when I think of their stated reasons reasonably.
A DNR order refers to a medical direction showing a person’s decision not to receive medical care of cardiopulmonary resuscitation (CPR) or any other life-sustaining medical care in palliative care. However, the value of life and its sanctity remains standing in the midst of every difficult situation of DNR decision-making from the perspective of healthcare professionals and patients’ families. The decision made by the medical facility to uphold the patient’s DNR order given in the form of a tattoo on his chest raises mainly questions regarding the ethical implications and the reasonable status of the law in such a context (Aziz et al., 2015). In the case scenario, while the medical professionals first tried to restore the patient’s health stability, there was a dilemma on whether the tattoo on his chest about the DNR order was to be followed. But after consultation with the ethics committee and the social work support team, they decided to uphold the law in such a context regarding patient autonomy (Aziz et al., 2015). On the reasoning of the ethics committee, the patient’s tattoo DNR order might be an authentic preference, and it might be seen as a caution or as standing on ceremony and that the law does not nimble enough to support such a decision not to follow DNR,
The laws of Michigan state provide clear legal provisions and circumstances under which a DNR order should be given and followed. From the legal provisions, there are two legally allowed forms or ways through which a patient may provide a DNR order; One is through a physician ‘s order for scope treatment (POST). The state of Michigan acknowledges that patients willing to undertake an end of life care can take a DNR by filling in a POST form. The form allows them to provide information on what should be done in regard to their end-of-life sustaining measures or resuscitation. The second legal provision of the state of Michigan is that a person can provide a DNR order by filling in a DNR conform Care Form. The form is legally supposed to be filled by the patient, parent, guardian, or any other healthcare representative (Michigan’s Do-Not-Resuscitate Procedure Act, 2023).
The decision of the ethics team does not, first of all, infer or align with the legal requirements. Under the two legal circumstances of DNR order approval, there is sufficient proof that they followed the law. The ethics team’s decision was out of line with the law. They decided based on the tattoo statement on the patient’s chest with no closer link to how the law, even though they inferred to law. The first legal circumstance under which a DNR order can be given is through a POST form. In the case scenario of the 70-year-old patient, there was no evidence of such a form being filled. The patient was admitted in an unconscious state and unable to speak and give instructions on what end-of-life care resuscitation or life sustenance measure to be taken by the healthcare professional. The DNR Act of Michigan states that the form can be completed if a person has discussed the issue with his or her physician, but in this case, there was no discussion since the patient arrived in an unconscious state (Michigan’s Do-Not-Resuscitate Procedure Act, 2023). Analysis of the same case under the DNR Comfort Care Form showed no guardian, patient, parent, or healthcare professional. It allows patients to express their decisions and consent on why they want a DNR. But in this context, there was no discussion between the patient and the healthcare professionals to express their consent (Walkey et al., 2016).
Nevertheless, from an ethical perspective, the ethics team violated the ethical values which hold life as a sacred institution. It is unethically wrong to first of all execute a DNR order since it acts as s form of murder even though the law does recognize such a provision. However, under society’s religious values, a DNR order is not allowed in Christianity, for instance (Walkey et al., 2016). Instead, death is allowed to take its natural state or process.
Besides, the ethical committee’s decision undermined the autonomy or consent of the patient personally. They should have acted on a DNR order given by the patient based on his autonomy and the patient’s rights being exercised. However, their decision violated the informed consent or autonomy of patients. In addition, as healthcare professionals, their roles are to provide care to the best level with the intention of not harming the patient but ensuring the medical care provided, whether physical or by instructions verbally and psychologically, is intended to better the health of a patient (Curtis et al., 2020). Considering that there was no verbal confirmation from the client on a DNR order, the ethic’s team decision is considered unethical and contributed to a life being taken away (Curtis et al., 2020). Likewise, their decision could probably lead to psychological trauma or pressure on the patient’s family if they discovered that they did such an act of ordering a DNR order to be executed based on such a tattoo on his chest with confirmation from him verbally there in the medical facility or presence of any other close relative family (Curtis et al., 2020).
In conclusion, end-of-life care comes with ethical and legal dilemmas that physicians and the entire healthcare professional team involved in patient care must face. A DNR order is one of them, which presents itself differently. In the context of the case scenario of a 70-year-old unconscious patient with a DNR order statement tattoo on his chest, the ethics team or committee and social work support decision is unethical. It does not also abide by the state of Michigan laws on DNR. The reason is due to the ethical values of healthcare such as patient autonomy, informed consent, value of life, responsibility of healthcare professionals such as non-maleficence and beneficence, and Michigan DNR statutes violation.
References
Aziz, H., Branco, B. C., Braun, J., Hughes, J. D., Goshima, K. R., Trinidad-Hernandez, M., … & Mills Sr, J. L. (2015). The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations. Journal of Vascular Surgery, 61(6), 1538-1542. https://doi.org/10.1016/j.jvs.2014.11.087
Curtis, J. R., Kross, E. K., & Stapleton, R. D. (2020). Addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19) is important. Jama, 323(18), 1771-1772. doi:10.1001/jama.2020.4894
Michigan’s Do-Not-Resuscitate Procedure Act. (2023). Www.michigan.gov. https://www.michigan.gov/mdhhs/adult-child-serv/adults-and-seniors/sevicesseniors/endoflife/circle/michigans-do-not-resuscitate-procedure-act
Walkey, A. J., Weinberg, J., Wiener, R. S., Cooke, C. R., & Lindenauer, P. K. (2016). Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia. JAMA internal medicine, 176(1), 97-104. doi:10.1001/jamainternmed.2015.6324
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