Martha must have been unconscious after she suffered the cardiac episode. She therefore had no intact decision making capacity. However, she had made it clear to her daughter Alice that she never wanted CPR, something that Alice intimated to the hospital authorities before she left. This ought to have been respected. Martha's condition could not be cured.
Even if CPR was administered, the quality of her life was so poor that meaningful survival was not expected. Respect for autonomy requires that the patient and/or their family members be allowed to play a role with regards to Do-Not-Resuscitate Order. Written DNR Orders must be cosigned by the attending physician (University of Washington School of Medicine, 2008). Alice actually singed the color-coded DNR order.
However, we are not told whether the attending physician signed it. It could have been ethically wrong not to subject Martha to CPR...
Both signatures had to be there. The caregivers must have been in an ethical dilemma when Martha suffered a cardiac episode. Nevertheless, they had to act, hence their decision to call 911 and Martha's subsequent subjection to CPR. The case also raises a very important ethical issue with patients under long-term care.
This deals with intact decision making capacity. Martha mooted her discomfort with CPR long before she suffered the cardiac episode. At this time, she was competent enough to make decisions for herself especially regarding refusal to be administered CPR. Out of respect for autonomy, her request should have been honored.
Reference
University of Washington School of Medicine, (2008). Do not Resuscitate Orders. Retrieved September 20, 2012 from http://depts.washington.edu/bioethx/topics/dnr.html
