Ethical Issues in Death and Dying
The Issues
 The outcomes related to their care
should be their own wishes
 The decisions may involve the choice
for:
- Organ and tissue donations, advance
directives, and resuscitation
Advanced Directives
- a general term used to describe the
documents that give instructions
about future medical care and
treatments.
- Advance directives include:
o living will, DNR, withholding
or withdrawing treatments.
Living Will
- the lay term used frequently to
describe any number of documents
that give instructions about future
medical care and treatments or the
wish to be allowed to die without
heroic or extraordinary measures
should the patient be unable to
communicate for self.
- No uniformity in laws on living wills
and surrogate decision makers.
- In some states, the advanced
directives go into effect only if a
patient is terminally ill and death is
imminent.
- Due to inconsistencies and
limitations, many authorities
recommend the use of durable
power of attorney over a living will.
Durable Power of Attorney
- A power of attorney is a legal
document that gives someone you
choose the power to act in your
place. In case you ever become
mentally incapacitated, you’ll need
what are known as “durable” power
of attorney for medical care and
finances.
- This allows you to name someone as
proxy, with the authority to make
medical decisions on your behalf
should you become incompetent
and unable to make the decisions
yourself.
Do Not Resuscitate (DNR)
- A written physician’s order
instructing health care providers not
to attempt CPR
- Often requested by family
- Must be signed by a physician to be
valid
- Several types of CPR decisions can
be made including:
o Full code, chemical code,
DNR or “no code”, slow
codes.
DNR Orders: Full Code
- A call for CPR efforts
- Contains all elements of ACLS
(oxygenation, ventilation, cardiac
massage, electroshock as necessary,
emergency drugs)
- “Code Blue”
DNR Orders: No Code
- Do not resuscitate
 - Written order placed in medical
chart to avoid the use of CPR efforts
DNR Orders: Slow Codes
- Health care team slows the process
of emergency resuscitations so as to
appear to be providing the care but
in actual fact is only providing
illusion
- Intent is more for family comfort
than patient benefit
DNR Orders: Chemical Code
- Provides the drugs needed for
resuscitation but does not provide
the other services.
- Emergency drugs only
DNR Guidelines
- DNR orders should be documented
- DNR orders should specify the exact
nature of the treatments to be
withheld
- Patients, when they are able, should
participate in DNR decisions
- Decisions to withhold CPR should be
discussed with the health care team
- DNR status should be reviewed on a
regular basis
ETHICAL ISSUE