Free New York DNR Order Essay Sample
Cardiopulmonary resuscitation (CPR) is known as one of the long-standing medical procedures in history that dates back in the 1960s. It was introduced to the public and developed for the purpose of reversing cardiac arrests happening while in the middle of surgery. In the year 1974, the American Medical Association created recommendations for a patient’s inclination towards a “code status.” This recommendation is in other words if they would want to receive CPR or would opt not to receive the procedure. This option will be documented in the hospital’s records as per the recommendations of the American Medical Association (Humble, 2014).
In the middle of the 1970s, hospitals started a trend of institutionalizing CPR as the initial response to cardiac arrest. By the following fifteen years, legislations from the Congress, presidential ethics commissions, and different rulings from judiciaries recognized that capable patients have the right, not to agree to life-sustaining treatments. This option is given through both a substitute decision-making process and in highly developed imperatives; thus the term do-not-resuscitate. Do-not-resuscitate (DNR) was initially provided particularly through the medical orders written by a doctor. The medical order instructs health care providers not to perform CPR at any time a cardiac arrest happens (Humble, 2014). According to the National Institutes of Health, as reported by Humble (2014), a do-not-resuscitate-order (DNR) is an order written by a doctor. This medical order instructs health caregivers not to provide cardiopulmonary resuscitation, or CPR, in the event that the heart stops beating or if breathing stops. In addition, the DNR allows a person to choose an emergency situation whether or not to get the CPR. This decision will only be in the matters of CPR. The DNR order does not affect other treatments. These treatments include medicines, pain medicine, or nutrition. The medical doctor writes the order or the instruction only after discussing it with the patients (if probable), the family or the substitute.
The DNR option is deeply embedded in our medical practice that it is already considered as a “patient order.” In most health care units in the United States, if the patient does not wish to give the imperative, not to resuscitate then it is already implied that a CPR will be issued. In some states such as in New York, the state has established a law to presume resuscitation in the absence of the order, not to resuscitate. In most facilities, hospital guidelines show that a CPR will be executed in the absence of the DNR order because of the emergency level often connected with the CPR system. In addition, even those areas and institutions without specific regulations on DNR, find it necessary to conduct CPR in emergency situations even in the event that the medical team does not find it warranted.
According to Zinn (2012) a do-not-resuscitate order shall mean that a patient should be allowed to die in a natural manner. Natural in the sense that no resuscitation is given in any event that the patient would need CPR especially in cases of cardiac or respiratory arrest. A DNR order is given by the patient. It is, however, important to note that a DNR does not mean withholding a treatment if the patient would require medical attention. Clinical professionals may also have varying opinions or interpretations of what a DNR order denotes. This varying opinion happens mostly when a patient is currently under a surgical procedure that requires the application of anesthesia. In this event, a DNR may produce ethical questions of how to properly care for a patient while at the same time considering the patient’s wishes and morals (Zinn, 2012). At present, the Joint Commission on Accreditation of Healthcare Organizations deems it necessary for health care organizations to have procedures and policies that pertain particularly to highly technical directives. The directives mentioned at the former includes DNR orders on all of their patients (Humble, 2014).
The debate of safely caring for a patient while at the same time granting their rights has also moved perioperative professionals to view DNR orders as inconsistent with the application of anesthesia and surgeries. This fact is why historically, DNR orders have been deferred to the peri-anesthesia stage of a patient. It was not until during the 1990s that DNR orders in the operating room and the issues alongside with the order were first focused on in the literature concerning anesthesia procedures. In the year 1993, the American Society of Anesthesiologists created documented procedures that address the issues and concerns regarding DNR orders. The necessity to follow a patient’s imperative and the weight of these orders as they relate to the patient’s surgical need is also included in the written guidelines regarding DNR.
In the United States, the do-not-resuscitate (DNR) order is entrenched in different hospital policies and the minds of many American doctors. In addition, individual state regulations each have their documented regulations in terms of DNR orders. New York for one, has its well-guided policy on the DNR of patients. Since 1988, the state of New York has already enacted its DNR law. The regulation was created for the sole purpose of clarifying and strengthening the rights and duties of patients. The regulation also covers the duties of their families and the health care professionals regarding the application of CPRs or issuing orders of not to resuscitate (Bishop et.al, 2010). As noted by Bishop et. al. (2010), regulating the right to issue DNR orders to clinical professionals was aimed by the state of New York to increase the degrees of care to patients. These patients include those who were seriously ill and the degrees of the communication between the doctor and the patient.
However, since the year 1988, a major flaw surrounding the guidelines for DNR was found. According to Bishop et. al (2010), the state of New York has at that time presumed that all residents of New York consent to CPR during medical emergencies. In the course of time, a disseminated pamphlet in the year 1992 was given jointly by the New York State Task Force on Life and the Law and the New York State Department of Health. The pamphlet established specific standards of practice for an attending physician. These standards of practice confirmed that if, through a second opinion, a CPR is found to be futile medically, a DNR will be issued. The statement was justified by the medical community by creating a DNR order over that of the objection of the patient’s health care substitute. In the year 2003, the New York Attorney General Eliot Spitzer has instead asserted that a physician must obtain first the consent of the patient’s health care replacement before issuing a DNR order. This regulation applies even in the event where a CPR is found to be medically futile.
Because of the sensitivity of the matter, the New York Government has already established procedures and requirements to guide health care professionals in carrying out DNR policies. They have what they call the “Out of Hospital” DNR. According to their website, the State of New York has an approved customary Out of Hospital DNR form (Appendix A). The said form is legally known in the whole state for DNR requests outside listed licensed institutions. This form is only intended for persons or patients who are not from a hospital or nursing home. The state DNR form is widely available through their website. According to the Department of Health of the New York state, there are NO other forms allowed or approved when considering an out of hospital do-not-resuscitate order. Aside from a DNR form, the State of New York also has created a recognized DNR bracelet. The standard and approved metal bracelet is worn by a patient. The bracelet includes a caduceus and the phrase “Do Not Resuscitate.” In the event that EMT’s are called they must already assume that a DNR order is given through the presence of the bracelet. If the patient is seen having the bracelet, it is no longer necessary to present the documented DNR order.
The Requirements of a DNR in New York
The validity of a DNR order, as enumerated by the state of New York, states that by merely presenting the signed Out of Hospital DNR form or a DNR bracelet to the EMT validates the request. Also, the form or the bracelet is valid if the patient comes from the house, hospice or clinic. A witness who is dependable and who can consistently identify the patient is also greatly needed in these circumstances. Another good thing to note is that these Out of hospital DNRs do not expire. For as long as the patient holds the DNR form or bracelet, its validity is encompassing.
If the patient is found in a hospital or nursing home, all licensed facilities, as listed in Article 28, are required to review, issue and maintain DNR mandates. EMS providers must acknowledge hospital DNR orders when transporting patients from their originating areas. The same expiration policy applies for DNRs issued within hospitals; they cannot be expired. The hospital or facility employee must then provide a copy of the DNR order or the patient’s chart with the said order to the present ambulance responder. There are, however, certain events where an EMS may disregard an Out of Hospital DNR order. First if there is a scenario where there is sound evidence to believe that a DNR order has been revoked. Second, if the patient is found conscious and wishes to ignore the DNR form. Third if the patient is unable to state his or her wishes, a family member may request resuscitative measures. Lastly, if a present physician mandates that the order must be ignored.
In order to examine the validity of the DNR in the whole of New York, it would be best to review three hospitals and their practices regarding the DNR order. First hospital to consider is the established Syracuse University Hospital. According to their handbook of patient’s rights, any adult patient with a decision-making capacity is eligible to request for a DNR order. However, before agreeing to issue a DNR order, patients, and their respective families must first discuss with a doctor the implications of a CPR and the patient’s diagnosis. According to their Handbook of patients’ rights, they also abide by the New York State law’s guidelines that all adult patients may request a DNR verbally or in writing provided that there are two witnesses present. Also, as guided by the health care proxy law, the hospital allows a patient to appoint an individual to make decisions about the DNR. The hospital does not use a separate form for the DNR. They use and require patients to sign the form required by the state government. In the event that a patient is found to be in an emergency situation out of the hospital, the same rules from the Department of Health apply to the hospital.
Even while looking at the guidelines for the St. Joseph’s Hospital in Syracuse, the same conditions apply when patients with DNR orders are treated. The hospital honors the DNR state form and proceeds with the other necessary treatment for the patient. As one of their guidelines, patients will still receive the necessary medicines, pain medication and nutrition with the exclusion of a CPR during cardiac arrests. They also do not have a separate DNR form for their hospital as the state fully imposes the standard DNR form. The St. Luke’s Hospital in New Hartford also follows the directives of the state as evidenced by issuing the statewide patient handbook. This mandate is found in their guidelines for patients.
Bishop, J. P., Brothers, K. B., Perry, J. E., & Ahmad, A. (2010). Reviving the Conversation Around CPR/DNR. American Journal of Bioethics. doi:10.1080/15265160903469328
Brindley, P. (2013). Perioperative do-not-resuscitate orders: it is time to talk. BMC Anesthesiology, 13(1), 1-3. doi:10.1186/1471-2253-13-1
Humble, B. (2014). Do-Not-Resuscitate Orders and Suicide Attempts. The National Catholic Bioethics Quarterly, 14(4), 661-671.
St. Joseph’s Hospital. (n.d.). Patient FAQs. Retrieved from http://www.sjhsyr.org/patient-faqs#.VNh639KUfts
St. Luke's Hospital. (n.d.). Advance Directives | Faxton St. Luke's Healthcare. Retrieved from http://faxtonstlukes.com/advance-directives
Upstate University Hospital. (2014). Patient handbook: a guide to patients' rights. Syracuse, NY: Author.
Zinn, J. (2012). Do-Not-Resuscitate Orders: Providing Safe Care While Honoring the Patient’s Wishes. AORN Journal, 96(1), 90-94.