Ethics

Ethics Study Guide he/she become incapacitated. These documents have been very instrumental in resolving ethical dilemmas. 8.6 Resuscitation Some terminally ill patients may decide that, should a cardiac event occur, they do not want to be resuscitated. They would ask their physician for a Do-Not-Resuscitate (DNR) Order. Physicians have the ethical obligation to honor their patient’s wishes regarding resuscitation. DNR orders might be granted for: • Patients for whom CPR would not provide any benefit; • Patients who could have permanent damage, unconsciousness, and poor quality of life if they survived CPR; or • Patients whose quality of life is poor and who wish to forego CPR in the event that breath or heartbeat cease. Mechanical ventilation is the most common form of life support that is withdrawn when death is imminent. Mechanical ventilation involves tubes inserted through the nose or mouth into the trachea, and through a machine, where a patient’s lungs are inflated and emptied, and allowing oxygenation of the blood. Some care providers consider mechanical ventilation as death-delaying, rather than life- prolonging. Patients, nevertheless, can decide that this is an intervention they do or do not want during their final days. 8.7 Hospice Hospice care, a holistic and philosophical approach to end of life care, emphasizes pain control, symptom management, natural death, quality of life, and providing physical comfort for the patient. Unfortunately, access to hospice services is not fair and equitable in the United States. This is partially due to governmental limitations on reimbursement to hospice organizations for Medicare patients. Some hospice programs might also ask patients to sign agreements that they must stop any curative treatments. Hospice also requires that patients have a prognosis of six months or less to live to qualify for hospice care. Some ethical questions concerning prognosis are: 1. Accuracy: Considering the unpredictability of disease, and the vast number of unknown variables that can influence how and when a person will die, it is difficult to come up with an accurate prognosis. 2. Six-month limitation: This requirement leaves out people who are near the end of life, but might have longer than six months to live. These individuals would be able to benefit from the hospice team and the many services it could offer. ©2018 Achieve Page 62 of 116