The keys to the policy are severely chronic illness as represented by the patient's declining functionality; and that death is imminent. It is a policy that advocates the right of a patient to forego life sustaining technology and intervention in what is constituted as legal death when the patient's heart stops and, without CPR which could ostensibly revive the patient to life, is final death for the patient. The policy resolves decisions of the healthcare provider and the healthcare staff to act in response to the patient's cessation of life.

Today, unless a DNR order is signed by the patient or the patient's family rights designee, then the hospital staff responds to the cessation of patient life with life-saving CPR techniques. The mandate would eliminate this automatic response in cases where there was no DNR on file if the patient's condition of chronic illness is one that will result in imminent death even if the life reviving CPR is successful. This means that patients with conditions such as cancer, heart disease, and other diseases of major organs, or conditions which, like that of Terri Schiavo, whose bodies can be sustained by artificial support systems, but who would otherwise die; would be allowed to die without the intervention, and could die in peace and dignity through natural life and death processes.

It would bring to an end the public involvement, and religious organizations' involvement in the end-of-life decision making process. The process of dying would become one that is based purely on a patient's medical condition, choice, in cases where the DNR is part of the patient's care plan, and CPR would no longer be an automatic emergency response of medical personnel in cases when a patient's life ceases naturally.

The policy is not a vehicle for arbitrary decision making by the family or by medical personnel. It must be predicated on informed decision making, and that information must be made available to the patient and to the patient's family. The question of whether or not the medical provider or provider personnel failed to act appropriately should not rise as a question, because the patient and the family will be provided details of how that action is decided before the need for such action, or lack of action, arises. The DNR process must be a part of the EOL counseling provided to patients and families in settings other than hospice settings where the nature of the setting denotes an understanding that death is imminent.

A specific and distinct document that outlines the mandate should be part of every admission hospital, nursing home, long-term care facility, and hospice admitting package. The form should require a criteria-by-criteria review with the patient or the patient's designated healthcare decision maker, and require the signature of both the EOL counselor and the patient, or the patient's designated decision maker and authorized signer for services and care. During the course of care, the patient and/or patient's family should have access to an EOL counselor to whom questions can be directed, as well as the patient's attending or primary care physician.

A DNR mandate will eliminate future court proceedings, public involvement, and Congressional oversight...

DNR should not be confused with termination of life, because the healthcare provider and provider personnel's inaction in providing the patient life reviving CPR is not terminating life, because life has already ceased at the point when CPR might otherwise be administered to revive a patient who might then go on to enjoy a natural period of life which would not be otherwise expected to cease within days or even weeks of the revival of the patient.
DNR is a personal medical right. It should be part of the EOL planning that each person should consider and discuss with family members prior to the point where an individual becomes incapacitated and unable to make the decision for his or herself. In cases where the patient's condition is brought on by an accident or other condition that is not anticipated as a result of disease or natural dying processes, then it becomes incumbent upon medical providers and personnel to inform honestly and truthfully family and decision makers about the DNR mandate and why the mandate would apply to their family member or loved one.

The question of whether or not the mandate is one of medical choice or institutional financial consideration is one that will no doubt be raised. Yes, the DNR mandate would save the medical provider the cost of personnel and technology associated with administering CPR to a patient who might be revived, only to die within days or weeks of that life-saving effort. Again, the key is that the patient's death is imminent, and that while CPR might revive life for the short-term, death will follow regardless of the effort. This is a mandate that is about the patient's right to die a natural process, and one that brings about an end to what is presumably a lack of quality and duration of life as a result of natural causes or causes that interrupted the quality and duration of individual life.

Reference List

Dubbler, N. And Nimmons, D. (1993). Ethics on Call: Taking Charge of Life and Death

Choices, Harmony Books/Crown Publishers, New York: New York.

Jones, M. And Marks, L. (1999). Disability, Divers-ability, and Legal Change, Martins

and Nighoff Publishers, Kluwer Law International, The Hague, Netherlands.

Kieman, S. (2006). Last Rights: Rescuing the End of Life from the Medical System,

Kieman, C. (1973). The Enlightenment and Science in Eighteenth Century France, (Vol

59 of Studies on Voltaire and the Eighteenth Century), Voltaire Foundation, University of Oxford, United Kingdom.

Leonhardt, D. (2009). After the Great Recession, New York Times Magazine, May 3,

2009, p. MM36; found online at http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=1, retrieved November 9, 2009.

Walter, J. And Shannon, T. (). Contemporary Issues in Bioethics: A Catholic Perspective, Rowman and Littlefield,

It should be noted that the severity of the conditions from which Kervorkian's patients suffered have been challenged. Kervorkian's second assisted suicide, a 58-year-old woman, Marjorie Wantz, suffered from a severe pelvic pain the cause of which physicians had failed to diagnose (Jones and Marks, 1999, p. 277).