Do Not Resuscitate Orders

Do-Not-Resuscitate Orders
Leigh Schuldt
Do-not-resuscitate orders (DNR) are a request by people to not have CPR preformed on them if their heart would stop or if they would stop breathing. “All patients should be encouraged to express in advance their preferences regarding the extent of treatment after cardiopulmonary arrest, especially patients at substantial risk of such an event” (Ray). If a person has previously stated their wants if his or her heart would stop then they would not be able to receive CPR by doctors and nurses. Even if the doctors thought that the individual would survive, they have to follow the orders set earlier by the patient, and not perform CPR on him or her.
Do-not-resuscitate orders are helpful, because individuals may suffer after being resuscitated, it is almost impossible for the patient’s family members to know how to react and the individuals should be able to make their own choice whether they live with suffering or not.
Some people who were resuscitated after their heart stopped beating or they stop breathing have to suffer the rest of their life, because CPR was performed on them when it was not in their best interest. In one study of life after CPR of 948 admissions during which CPR was performed, 61.2% of patients survived the arrest and 32.2% survived to hospital discharge. One year after hospital discharge, 24.5% of patients, regardless of age, had died” (Zoch). Another study found that “patients who have recovered from a circulatory arrest after CPR resuscitation find their capacity for resuming work diminished after discharge from the hospital, while they seem to experience a postponed negative effect on their mental functioning, especially the functions connected with the awareness of their environment” (Peterson).
People can suffer from CPR after their heart stops and in many cases families argue with each other on what they believe is the best for their family members. In many cases, the person who is critically ill may prefer to die, but the family does not want to let them go. The family may feel as though the ill person is still mentally there and they want to try to keep their family member around. This is when having a DNR order would be a good thing for the patient, family and the doctor. The patients would then not have to worry about what would happen to them if they were put in this situation. They would be able to decide before hand, if they would like to have their hearts restarted if their hearts would stop beating. When the people themselves decide this beforehand, then it is much easier for the family to not have to try to decide what to do in such a situation. This can be a hard thing for a family to deal with, because family members have a hard time trying to decide what to do with their loved one.
The council on Ethical and Judicial Affairs for the American Medical Association suggested these guidelines for the use of DNRs in 1991: “a patient may express in advance his or her preference that CPR be withheld… Also, CPR may be withheld if, in the judgment of the treating physician, an attempt to resuscitate the patient would be futile” (JAMA). Individuals should have the choice to decide whether they would like to have their heart restarted or not. Most doctors believe that the individual should decide what would be the best for him or her, if they were put in such a situation. “Over the last decade physicians and patients' families set limits earlier and more frequently in cases likely to have poor outcomes” (R. L. Jayes).
DNR orders are helpful for individuals whose heart has stopped beating, because individuals may suffer after being resuscitated and the individuals should be able to make their own choice whether they live with suffering or not. People should think about what they would like to happen to them if their heart would stop or they stopped breathing. People need to decide if they would want to have their heart started again and have the chance of living by the help of machines or would they rather like to pass on and not have to live with the pain of trying to stay alive.

Work Cited
R. L. Jayes, J. E. Zimmerman, D. P. Wagner, E. A. Draper and W. A. Knaus. November 10, 1993. Do-not-resuscitate orders in intensive care units. Current practices and recent changes. Vol.270 No. 18. The Journal of the American Medical Association. Retrieved 1/11/08.

MW Peterson, LJ Geist, DA Schwartz, S Konicek and PL Moseley. Department of Medicine, College of Medicine, University of Iowa, Iowa City. Chest, Vol. 100, 168-174. Retrieved 1/21/08.

Thomas W. Zoch, MD; Norman A. Desbiens, MD; Frank DeStefano, MD; Dean T. Stueland, MD; Peter M. Layde, MD. Short and Long-term Survival After Cardiopulmonary Resuscitation. Arch Intern Med. 2000; 160:1969-1973. Retrieved 1/21/08.

Council on Ethical and Judicial Affairs, American Medical Association. Guidelines for the appropriate use of do-not-resuscitate orders. The Journal of the American Medical Association. Vol. 265 No. 14, April 10, 1991. Retrieved 1/23/08.

Priscilla Ray, MD. Council on Ethical and Judicial Affairs. Do-Not-Resuscitate Orders. Retrieved 1/22/08

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