DNR: LEGAL

AND MORAL
CHALLENGES
TO HEALTH
PROFESSIONALS
PREPARED BY: HYDE
BACALUCOS, MARISSA ASIM,
ROSA MAE GUMILAO, ROSE LAIN
FERNANDEZ, SHALAMAE
SALIALAM, RHIDAB TUTI, LESLIE
PALACIO, VHINCE PISCO
INTRODUCTION
 LEARNING OBJECTIVES

▪ At the end of the discussion, the students will be able to;

▪ Understand the principles, concepts and moral challenges of DNR to Health Professionals.
▪ Recognize the ethical complication of DNR orders.
▪ Recognize who are the candidate for DNR.
▪ Understand the role of patient and parent in minor children.
▪ Understand the importance of proper documentation.
 CONTENTS

▪ Do not resuscitate order (DNR order), an advance medical directive

that requests that doctors do not attempt cardiopulmonary resuscitation
(CPR) if a person’s heart or breathing stops.
▪ Emergency care and other health care providers may still continue to
administer oxygen therapy, control bleeding, position for comfort, and
provide pain medication and emotional support.
▪ If individuals are considered rational and able to communicate their
wishes in a clear manner, they may write their own advance directives
indicating a desire for a DNR order.
 DNR in the OR

▪ Health care institutions should promote opportunities

for a careful, informed discussion about potential
resuscitative measures between the patient (or
surrogate), surgical, and anesthesia teams, before a
planned procedure in order that a treatment approach
best matches the patient’s goals of care and medical
situation.
Does a DNR expire?

▪ DNR orders must be dated. Depending on the state,

orders may expire after a certain amount of time or
there may be a deadline for the physician to follow
up.
DNR SAMPLES (INSTANCES/CONDITIONS
WHERE DNR IS APPLIED)
CASE ANALYSIS
1929-2019
 CASE ANALYSIS I

▪ Case Scenario
Mr. A. is a 46-year-old man with multiple myeloma began experiencing acute pain in his right
lower abdomen. At 2'o clock, Mr. A's wife took him to the emergency department for diagnosis
and treatment. Examination revealed lower right abdominal tenderness with rebound pain and lab
results confirm high white blood cell count. The physician diagnosed acute appendicitis. When
Mr. A's old chart was brought to the emergency department, the physician discovered a DNR
order that was placed there during Mr. A's last hospitalization for cancer treatment. The physician
approached Mr. A. to discuss this DNR order, particularly its applicability during surgery.
Mr. A. insisted that the DNR order must still be followed. The oncall surgical team was preparing
for the emergency appendectomy when the physician relayed Mr. A's wishes about the DNR
order during this surgery. The circulating nurse, whose father also had been diagnosed with
multiple myeloma, refused to follow the DNR order. She explained that she had noted from Mr.
A's chart that the patient had a wife and 2 small children, and she did not believe that Mr. A.
understood how important the remaining time of life would be for him in helping to prepare his
family for his impending death.
 CASE ANALYSIS II

Mrs. K was taken to Oak Grove Nursing Home by her daughter the other day. It’s Alzheimer's
disease has wreaked so much havoc on her that her daughter, can no longer care for her at
home. Oak Grove has a dedicated unit for Alzheimer's patients, and her daugther discovered it
during her investigation that friends who have used the facility for both long-term and short-
term automobile care have highly recommended it.
The move to the care facility had been planned for several weeks, but when the time arrived,
Her Daugther discovered that her mother was particularly frail. When they arrived at Oak
Grove, the staff made Mrs. K feel welcome and started working on the paperworks. Her
daugther soon excused herself, claiming exhaustion, and she left with only a few of the
paperwork signed.
 CONCLUSION

▪ DNR does not lead to cessation of appropriate medical care however, it aims to avoid non-beneficial
interventions.
▪ DNR does not mean that patients will die alone and uncared for; rather, when the end is near, the patient
will be placed under hospice care.
▪ The DNR order is the legal and medical document that reflects the patient’s decision and desire to avoid
life sustaining interventions.
▪ Do not resuscitate is a technique for the patient and his or her family to shorten the time of the patient’s
suffering before he or she dies.
▪ Discussion of DNR with patients and family should be included in all treatment modalities and balancing
between risks and benefits of each treatment.
▪ Many dying patients who have had cardiac arrest can have their suffering reduced by using DNR orders in
conjunction with sufficient palliative and end-of-life care.
▪ Although DNRs can be regarded as a form of passive euthanasia, they are not controversial unless they
are abused. (https://www.bbc.co.uk/ethics/euthanasia/overview/dnr.shtml)
 REFERENCES

▪ 
https://www.omicsonline.org/open-access/do-not-resuscitate-an-argumentative-essay-2165-73
86-1000254.php?aid=70041&fbclid=IwAR0M5noNhxJzm1i0T-Q-yeBv2R1oCGU9o2va_3vb
XjuZ8D_gIVALKaB4P8U
▪ Downar J, Luk T, Sibbald RW, Santini T, Mikhael J, et al. (2011)
 Why do patients agree to a do not resuscitate or full code order? Perspectives of medical inpa
tients. J Gen Intern Med 26: 582-587.
▪ Tierney E, Kauts V (2014)
 Do not resuscitate policies in the intensive care unit - the time has come for openness and cha
nge. Bahrain Medical Bulletin 36: 65.
▪ Journal of Palliative Care and Medicine
OPEN FORUM
THANK YOU!