Do Not Resuscitate Order's Nurse's Role Requires Moral Courage

Overview of the Article 

The article Do-Not-Resuscitate Orders: Nurse’s Role Requires Moral Courage by Vicki Lachman relates to the issue of care, which separates the practice of nursing from most of the other healthcare based professions. This is the issue of an order for a patient who gets cardiac arrests not to be resuscitated, known as a Do not Resuscitate (DNR) order. It is premised on the increasingly prominent notion that medical decisions should primarily be made by the patient or a surrogate appointed by the patient as opposed to the medical officer. According to the article, this decision ought to be made by the patient then reported to and registered by a licensed physician. However, the obligations of the nurse under the DNR order rules are more important than those of the doctor since care provision is a nursing specialty. This creates the obligation for a nurse to continually advise the patient on the changing circumstances of the patient’s position and how they affect the DNR order. In the case the patient is not in a position to make the decision, the obligation for the nurse moves to the patient’s loved ones. The situation is exacerbated by the fact that relatives mistake the DNR order for permission to commit euthanasia. 

Ethical Issue 

Care is the integral aspect of nursing but generally, a nurse is essentially in the business of healing. The possibility of healing, however, ends at death which is an eventuality that a nurse is well trained to avoid. DNR order involves a situation where means of avoiding the eventuality of death exist so as to provide the patient with an opportunity to be treated and perhaps cured. It is, therefore, the considered moral responsibility of the nurse to seek to avoid the death of a patient at all costs (Maxwell et al., 2014). However, the circumstances under which the DNR order was designed to operate are those where remaining alive is not in the best interests of the patients or their loved ones. 

The ethical duty of the nurse under this circumstance, however, is not only to advise the patient and/or the loved ones of the available options but also on which option they ought to take. Moral courage comes in because patients and their loved ones are inclined to live and will push for all probable forms of resuscitation even when there is little or any hope for future recovery. The situation is exacerbated by the popular depiction of resuscitation in television programs where full recovery ensues within minutes of resuscitation after a major cardiac arrest. The nurse is forced to advise the patient on a sensitive life and death issue, where the patient is inclined towards making the wrong decision and where the interests of the patient and those of the nurse as a normal human being are against the very difficult advice that the nurse is giving to the patient (Maxwell et al., 2014). 

Two exceptional circumstances make the already onerous obligation of the nurse in a DNR order situation much more complicated. The first is when the situation of patient changes or when the anticipated positive prognosis of a patient changes into a negative one. Under the two situations, the position under which the initial advice had been given changes which necessitate the giving of the new relevant advice (Dzeng et al., 2015). For example, a nurse who had advised a patient not to give the DNR order realizes the need to advise the patient to change the instructions and actually get a DNR order registered. The second extremity is when the nurse has to deal with a family situation where several children are of a majority age and the decision is up to them. The children will mostly be rooting for the recovery of the parent and finding the courage to convince them to give a DNR order would be extremely draining for any nurse (Fritz & Fuld, 2015). Therefore, ethics in a situation that warrants a DNR order require a nurse to go against the natural order of humanity and the nursing profession and advice the patient to choose not to accept a readily available possible solution to continue living hence the moral and ethical dilemma. 

References

Dzeng, E., Colaianni, A., Roland, M., Chander, G., Smith, T. J., Kelly, M. P., ... & Levine, D. (2015). Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life.  JAMA Internal Medicine ,  175 (5), 812-819 

Fritz, Z., & Fuld, J. P. (2015). Development of the Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a cross-disciplinary approach. Journal of Evaluation in Clinical Practice , 21 (1), 109-117. doi:10.1111/jep.12256 

Maxwell, B. G., Lobato, R. L., Cason, M. B., & Wong, J. K. (2014). Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order.  PeerJ ,  2 , e245