Deontology and DNR Orders: A National Policy Framework
This paper examines Do Not Resuscitate (DNR) orders through the lens of deontological ethics, arguing that the absence of a national policy creates moral distress for nurses and physicians and undermines patient autonomy. Drawing on Kantian duty-based ethics, the paper contends that care providers are ethically obligated to honor patient wishes regarding resuscitation. It then proposes a concrete national strategy: standardized admission forms, a federally accessible electronic health record database for advance directives, adoption of the Cleveland Clinic's DNR Protocol as a national standard, and revised nursing curricula grounded in deontological principles. Together, these measures aim to reduce care-provider discomfort and ensure consistent, patient-centered end-of-life decision-making across all hospitals.
- Introduction: DNR orders cause distress; national reform needed
- Current Policy on DNR Orders: No national DNR policy; communication gaps persist
- How Deontological Ethics Applies to DNR: Kantian duty ethics frames care-provider obligations
- Strategy for Addressing the DNR Issue: Standardized forms, EHR database, scripted language proposed
- Conclusion: National standardization reduces distress, honors patient wishes
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- Clearly anchors a practical policy problem in a named ethical framework (deontology/Kantian duty ethics), giving the argument both philosophical grounding and real-world relevance.
- Moves logically from problem identification (lack of national policy, care-provider distress) to ethical justification to a concrete, multi-part implementation strategy.
- Uses a real institutional model (Cleveland Clinic DNR Protocol) as a credible, ready-made national template, strengthening the feasibility of the proposed policy.
Key academic technique demonstrated
The paper demonstrates applied ethical analysis: it selects one ethical framework, explains its core principles (Kant's Kingdom of Ends, duty-bound obligations), and systematically maps those principles onto a specific clinical dilemma. Rather than surveying multiple competing frameworks abstractly, it uses deontology as a sustained analytical lens throughout — showing readers how a single theoretical perspective can generate practical, actionable recommendations.
Structure breakdown
The paper follows a problem–theory–solution structure. The introduction establishes the clinical problem and previews the three-part argument. The overview section diagnoses current policy failures. The ethics section supplies the theoretical justification. The strategy section — the longest and most detailed — translates theory into specific policy steps: standardized forms, scripted provider language, EHR databases, federal web access, and revised nursing curricula. The conclusion synthesizes all three threads into a unified rationale for national standardization.
Introduction
Do Not Resuscitate (DNR) orders are a significant concern for care providers in hospitals, particularly those working within hematology and oncology. As Weissman (1999) notes, DNR is a stumbling block for many nurses and nursing students. He describes, for example, how his students unanimously struggled to understand the purpose of asking terminally ill patients about their resuscitation preferences: "We know it's required under hospital policy to ask patients their preference about resuscitation, but these cancer patients . . . well . . . you know . . . they're dying . . . it doesn't make sense" (Weissman, 1999, p. 149). Weissman (1999) further observes that while DNR orders were "designed to ensure patient autonomy while at the same time identifying patients in whom resuscitation is not indicated," they have unfortunately come to serve as "an example of how a well-meaning application of modern medical ethics [leads] to untold patient/family suffering and… health professional distress" (p. 149).
To address the suffering and distress so often associated with DNR orders today, there is significant need to confront the issue at the national level — for two reasons: first, to establish national uniformity in the approach nurses must take; and second, to apply a sufficient standard that makes sense and can be followed with as little distress, emotional discomfort, and moral questioning as possible. This paper provides an overview of current policy regarding DNR orders, discusses how the deontological ethical system applies to the issue, and describes a strategic plan for addressing the issue at the national level.
Current Policy on DNR Orders
There is currently no national policy on DNR orders. Yuen, Reid, and Fetters (2011) note that DNR orders have been used by hospitals across the nation for more than 20 years, but that "as currently implemented, they fail to adequately fulfill their two intended purposes — to support patient autonomy and to prevent non-beneficial interventions" (p. 791). One of the major problems nurses have with DNR is that they find it difficult to sensitively broach the subject. Quite simply, they often lack the communication skills needed to discuss the matter with patients (Weissman, 1999). Ultimately, the problem is one of education: nurses are not trained within an appropriate ethical framework that can give them confidence and ease their moral concerns. They lack, in other words, an ethical perspective that can help them understand why it is important to discuss DNR with patients.
As Weissman (1999) argues, "we must seek DNR policy reform that brings the reality of CPR as a medical intervention in line with the professional responsibility of caring for the dying" (p. 150). That means a national policy must be devised to help nurses and physicians overcome their difficulties in discussing DNR — and that policy should be rooted in the ethical system of deontology.
References
Cleveland Clinic. (2018). DNR policy. Retrieved from http://www.clevelandclinic.org/bioethics/policies/dnr.html
Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: A narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.
Sen, A. (1983). Evaluator relativity and consequential evaluation. Philosophy & Public Affairs, 113–132.
Weissman, D. E. (1999). Do not resuscitate orders: A call for reform. Journal of Palliative Medicine, 2(2), 149–152.
Yuen, J. K., Reid, M. C., & Fetters, M. D. (2011). Hospital do-not-resuscitate orders: Why they have failed and how to fix them. Journal of General Internal Medicine, 26(7), 791–797.
Create your account
Always verify citation format against your institution’s current style guide requirements.