Legal and Ethical Issues of DNR

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All major religions agreed with the Pope. Thirty years ago, a DNR was impossible to obtain legally. In 1976, a New Jersey court ruled in the Karen Ann Quinlan case that all persons had the right to refuse treatment. However, it did not clarify how the right could be exercised without court review and on case basis. Doctors had to go to court to stop using extraordinary life support. They were driven by the "technological imperative...? to resort to extraordinary means, regardless of the futility of these means or whether the patient wanted them. But the decision on the June 30, 1978 case of Shirtly Dinnerstein changed all that. The court ruled that DNR orders could be issued without court intervention and placed the decision within the competence of the medical profession (Mass. App, 1978 as qtd in Mustagh). The decision became the basis of the President's Commission on Standards for Cardiopulmonary Resuscitation. It was later adopted by the American Medical Association, which clarified that "the purpose of CPR is to prevent sudden and unexpected death....? It is not meant to prolong life in terminal irreversible illness "where death is not un-expected...? and resuscitation is useless. The Association also emphasized that resuscitation in terminal cases may even violate the patient's "right to die with dignity....? Other medical groups duplicated the Association's initiative until the change got incorporated into medical standards throughout the country as well as in other countries. The emphasis shifted from prolonging the process of dying to promoting dignity. Doctors now balance benefit with burden. They exercise value judgments and make moral decisions with the patient and his family. Quality of life has since become the prime consideration and basis of the decision (Mustagh).

Ethical Theories and Issues

A DNR is guided by the ethical theories and principles of beneficence, non-maleficence, autonomy and justice (Pat et al, 2009).


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…[continue]

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