I.

Introduction
National Conference
Resuscitation

and

on

Standards

Emergency

Cardiac

for

Cardio-Pulmonary

Care

issued

revised

guidelines that stated: "When doubt exists...resuscitation should be

instituted. One of the situations in which CPR is usually not
indicated is the case of the terminally ill patient for whom no
further therapy for the underlying disease process remains
available and for whom death appears imminent."
A Christian assessment of the issues surrounding resuscitation
needs to start from the realization that however poor, ill, disabled
or even in pain a person is, his or her life is never futile. Human
beings are God-like beings. The Bible states that human beings are
made in Gods image a statement that says more about values
than physical attributes. Being made in Gods image means that we
should respond to each other with wonder, respect, empathy and
above all with an attitude that seeks to protect each other from
abuse, harm, manipulation and from willful neglect. A person who
is exceedingly ill is still a person. Even if a decision is made that
attempts at resuscitation are so unlikely to succeed that it would
be inappropriate to try, this does nothing to diminish the value
placed on the person.
Indeed recognising that a person is weak and incapable of selfdefence is useful as it highlights our duty of care. In this case we
have a responsibility to increase, rather than decrease, our effort
to care for the person. A consequence of this high view of life is
that we must distinguish removing suffering from removing the
sufferer. Any action that sets out with the intention of destroying a
human life desecrates Gods image. Just because these people or
their family may be becoming physically or financially exhausted,

this is no reason for taking decisions that will hasten the death of
another person.
Providing
regarding

patients
the

and

risks

families
and

with

potential

accurate

information

medical

benefit

of

cardiopulmonary resuscitation is also critical. Under certain

circumstances, CPR may not offer the patient direct clinical
benefit, either because the resuscitation will not be successful or
because surviving the resuscitation will lead to co-morbidities that
will merely prolong suffering without reversing the underlying
disease.
Another problem is that people tend to have an excessively
optimistic view of the chances of resuscitation being successful.
The reality is very different. To start with, resuscitation is seldom a
single event, but is a long-drawn-out string of interventions. This
includes electrically stimulating the heart, mechanically helping
the person breathe, and transferring them to an intensive care unit
for further treatment.
The principal intention of DNR is to prevent patients suffering
pointlessly from the bad effects that resuscitation can cause:
broken ribs, other fractures, ruptured spleen, brain damage while
neither cure nor recovery is possible. For example, there is
basically no chance that cardiopulmonary resuscitation (CPR) will
save the life of someone who has advanced cancer and heart
failure. In these sorts of situations the attempt to resuscitate is a
futile exercise denying the person a dignified death. If the patient
is elderly, there is a high chance that the force needed to compress
the chest will break some ribs. This causes intense pain and
complicates further treatment.
God-fearing medical intuition begins not with an analysis of the
patient's condition, but the motives of those making the decision

about treatment. A doctor who evaluates the value of life

subjectively and qualitatively is more likely to paint a dim picture
of outcome for CPR therapy. That doctor will be quick to
recommend a DNR order rather than risk survival of a patient
whose quality of life is diminished. On the other hand, a doctor who
sees life as having intrinsic value, who is rooted in Biblical
principles, will be more inclined to advise CPR and DNR decisions
from that perspective. Even though the ability of the medical
community to accurately predict treatment outcome is scarcely
better than a weatherman's success at predicting the weather, a
God-fearing doctor will advise with a backbone of Christian values
about God and about human life.
Instead, a Christian doctor is more inclined to be concerned that
the dying process not be artificially extended or suffering
increased.
Life is life. An individuals self-worth is not dependent on mobility
and/or function. Rather, it rests in the fact that every human has
been created in the image and likeness of God. Godnot manis
the One Who establishes humanitys significance.
http://www.christianliferesources.com/article/do-not-resuscitateorders-dnr-orders-144
The question of authority over life and death can be addressed by
the principle: God alone has the right to initiate and
terminate life. God's position on this matter is clearly stated in
Scripture. In Deuteronomy 32:39 God says, "I put to death and I
bring to life." Consistent with that position God strictly limits our
jurisdiction in this matter. In Genesis 9:6 he tells us, "Whoever
sheds the blood of man, by man shall his blood be shed; for in the
image of God has God made man". This latter point was well
summed up in the commandment, "You shall not murder."

A second principle addresses the controversial topic of "quality of

life." That principle is: While God demonstrates in his word
that there may be different qualities of life, he extends to all
human life an absolute value. In other words, God does not play
favorites, and neither should we. While recognizing there were vast
differences in the quality of people's lives, God nevertheless so
loved the "world," healthy and unhealthy, lame and whole, that he
sent his Son, Jesus, as their Savior (John 3:16).
A third principle is: A Christian both accepts and perhaps even
longs for death and the heavenly victory that comes with it,
but at the same time will seek to retain life as a time of
service to God. In other words, a Christian's reason for living life
is to serve God. Such service is God's purpose for life. That is why
the Apostle Paul, when considering the question of life and death,
said, "I am torn between the two: I desire to depart and be with
Christ, which is by better far; but it is more necessary for you that I
remain in the body" (Philippians 1:23-24).
Paul characterized the greater sacrifice to be that of continued life
for he knew what living meant. It meant a lot of personal labor and
hardship, but it was for the greatest of causes: the nurturing and
salvation of souls.
Paul also acknowledges that death does not come with fear for the
Christian. When he wrote to the Thessalonians, who apparently
mourned the death or deaths of fellow believers, he said,
"Brothers, we do not want you to be ignorant about those who fall
asleep, or to grieve like the rest of men, who have no hope. We
believe that Jesus died and rose again and so we believe that God
will bring with Jesus those who have fallen asleep in him."
"So whether you eat or drink or whatever you do, do it all for the
glory of God." Never forget that the entire decision process falls
under the broader umbrella which says, "Thy will be done."

Biblical teaching regarding the nature of man acknowledges that

he is composed of two distinct partsthe physical and the spiritual.
In 2 Corinthians 4:16, Paul wrote: ...but though our outward man
is decaying, yet our inward man is renewed day by day. In some
fashion, then, God has placed within man a portion of His own
essencein the sense that man possesses a spirit that will never
die.

Topic

CODE

BLUE!

CHRISTIAN

HEART

CRISIS:

RESUSCITATE?
Terminal care-Do Not Resuscitate
Purpose : At times, the laws of man are of little use, since what is
legal may not be

what is right in the eyes of God.

Similarly, our instincts and insights may be of no use,

since they often are clouded by

pain or

emotion.

Therefore, through this study process, we want to try to

understand the
Structure:

II.

Definition of Physicians Assisted Suicide Euthanasia: DNR

DNR in Medical Science
DNR in Christian World View
Interrelation DNR between Medical Science and Christian

World View in regrads to DNR

Definition of Physicians Assisted Suicide Euthanasia: DNR in
terminal care.
Euthanasia:
The painless killing of a patient suffering from an incurable and
painful disease or in an irreversible coma. (oxford dictionaries)
Euthanasia is an act whereby a physician intentionally causes the
death of a terminally ill patient. It differs from murder in that the

motive is seen as merciful rather than malevolent. The physician's

intent is to help the terminally ill patient avoid the suffering that
often accompanies the process of dying. (medscape)
According to BBC Ethics Guide, these are the different forms of
euthanasia
(http://www.bbc.co.uk/ethics/euthanasia/overview/dnr.shtml):
Active and passive euthanasia
In active euthanasia a person directly and deliberately causes the
patient's death.
In passive euthanasia they don't directly take the patient's life, they
just allow them to die. This can be done in 2 ways:
1. Withdrawing treatment: for example, switching off a machine
that is keeping a person alive, so that they die of their disease.
2. Withholding treatment: for example, not carrying out surgery
that will extend life for a short time.
Voluntary and involuntary euthanasia
Voluntary euthanasia occurs at the request of the person who dies.
Non-voluntary euthanasia occurs when the person is unconscious
or otherwise unable to make a meaningful choice between living
and dying, and an appropriate person takes the decision on their
behalf.
Involuntary euthanasia occurs when the person who dies chooses
life and is killed anyway.
Indirect euthanasia
This means providing treatment (usually to reduce pain) that has
the side effect of speeding the patient's death.
Assisted suicide

This usually refers to cases where the person who is going to die
needs help to kill themselves and asks for it. It may be something
as simple as getting drugs for the person and putting those drugs
within their reach.

DNR:
According

to

BBC

Ethics,

DNR

is

defined

as

(http://www.bbc.co.uk/ethics/euthanasia/overview/dnr.shtml):
DNRs are Do Not Resuscite orders. A DNR order on a patient's file
means that a doctor is not required to resuscitate a patient if their
heart stops and is designed to prevent unnecessary suffering.
The usual circumstances in which it is appropriate not to
resuscitate are:
when it will not restart the heart or breathing
when there is no benefit to the patient
when the benefits are outweighed by the burdens
The

UK

medical

profession

has

quite

wide

guidelines

for

circumstances in which a DNR may be issued:

if a patient's condition is such that resuscitation is unlikely to

succeed
if a mentally competent patient has consistently stated or
recorded the fact that he or she does not want to be

resuscitated
if there is advanced notice or a living will which says the

patient does not want to be resuscitated

if successful resuscitation would not be in the patient's best
interest because it would lead to a poor quality of life

Also, in the UK, NHS Trusts must ensure:

an agreed resuscitation policy that respects patients' rights is

in place
a
non-executive

implementation of policy
the policy is readily available to patients, families and carers
the policy is put under audit and regularly monitored

director

is

identified

to

oversee

Euthanasia differs fundamentally from the act of withholding or

withdrawing life-sustaining medical treatment. When physicians
forego life-sustaining treatments at the end of life for their
terminally ill patients, the patients die of their disease process.