Legal and Ethical Issues of DNR

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This moral or ethical theory obligates a doctor or person always to do what promotes the welfare of others (Pat et al, 2009). This consists of the elimination or prevention of harm in another person and contributing positively to his good or welfare. This theory compels the doctor or person to do what is in the best interest of the patient. It is most applicable in the case of a patient in permanent vegetative state when life-sustaining support is no longer in his best interest. Extraordinary means only prolong or extend the dying process and suffering on all sides without medical benefits. Preventing, eliminating or reducing suffering will be an act of mercy and beneficence. At times, death can be in the patient's best interests. Preserving his poor quality of life is tantamount to a denial of his well-being. Under this ethical theory, the decision not to resuscitate is morally right as it allows the patient to die in peace and dignity (Pat et al).


This theory forbids a doctor or moral agent from inflicting harm or evil on another person (Pat et al, 2009). It universally obligates all people to protect one another and themselves from harm. Disease is a kind of harm and treatment is meant to cure the disease and remove the harm. But when treatment becomes ineffective or useless, it turns into harm that assaults the patient. Even successful resuscitation can severely damage the patient's lungs, heart or brain if death is likely in a matter of hours or days. If the patient is successfully resuscitated and survives, he may remain in irreversible coma. The British Medical Association and the Resuscitation Council guidelines state that CPR should not be performed if it is not likely to be successful (Pat el). Thus, resuscitation will harm the patient rather than do him good.


This theory recognizes the patient's independence to determine the direction he takes as long as the rights and liberties of others are respected (Pat el, 2009). A competent patient should be treated as autonomous. He has the right to voluntarily choose treatments and procedures, including life support and extraordinary medical care (Kagawa-Singer & Blackhall, 2001 as qtd in Pat el) for himself. This right, however, can be affected by a defect in controlling his desires or actions. If he makes his wish known, his family and the doctor must follow it. If it is not known, he should be given CPR even if his family opposes it (Pat et al). This illustrates the inalienability of the right to life.


This means a fair, equitable and un-biased decision made in favor of the patient (Dunn, 1998 as qtd in Pat et al, 2009). The patient's right is, however, pitted against that of society. No one has the constitutional right to unlimited health care. Shortage of critical care beds, length of stay in the hospital and health care costs are among the non-medical considerations to a DNR. Terminal or end-of-life care exacts overwhelming costs with the least promise of return. It is, thus, deemed reasonable and just to restrict healthcare spending. Some institutions resort to rationing to protect autonomy while equitably apportioning available basic health care to those who stand the greatest chances of benefiting from it. In the face of real-life limited resources, the just choice is not to provide CPR to cases when CPR is unlikely to succeed (Curtis& Burt, 2007 as qtd in Pat et al). Similarly, resorting to extraordinary medical intervention to prolong the life of a terminally ill patient will mean depriving others who need the resources and stand a better chance at survival or cure. The utilitarian principle applies here. It states that limited resources should go to the greatest number with the greatest chance of benefiting (Pat et al)[continue]

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