DNR vs. Selective Euthanasia

[MrBishop]

DNR – Do Not Resituate - Basically a judgement call made by the Doctor and, in some cases the family*where present*, as to what a ‘heroic measure’ is and whether it should be administered.



Euthanasia – A decision made by the family to discontinue treatments or medication to a patient who requires it to continue living, or to administer medication in order to speed along the demise of the patient. (aka Assisted Suicide in the latter case)



Here’s the point. In the case of DNR…it’s up to the doctor and the family to decide how much effort should go into saving the life of the patient….in Euthanasia, it’s discontinuing an existing effort. There’s a fine line there… at what point does an existing effort go against the DNR’s Heroic Efforts clause and become stoppable?



Morally speaking…where would you draw the line between the two? One is a legal right and one is a legal conundrum, with a slippery slope attached to it for good measure.

 

[Dave]

if a patient has a valid, legal DNR, they shouldnt end up on life support in the first place. a DNR order is the family or patients choice. the doctor will only ask how far the family wants to go in the event the patient dies and there is no DNR present. if the family says "full code" (CPR, intubation, drugs) then thats how the patient will be treated.
the whole DNR thing can be very tricky. if, for example, a patient came into the hospital from a nursing home. the nursing home told us the patient was a DNR, but didnt send the proper paperwork, that patient is a full code until we get the paperwork. if they should happen to code (die), then we have to do CPR and the patient would be on life support. now if the family wants that discontinued, they have to go to court and convince a judge that this is what the patient wanted and have them removed from life support.
as far as speeding death up, no doctor can legally prescribe medications specifically to speed up a patients passing. there are indirect ways to do that, but directly is illegal.

 

[MrBishop]

You kinda lost me for a second with your medi-speak...but I think that I'll try to catch up.


You worked in Emergency...guy comes in..major GSW. Rushed to surgery to patch up a few arteries and re-inflate his lung... get sall the nice medi-toys. A few hours later...surgery's over..family shows up with a DNR...but the guy's on life-support.

 

[FluerVanderloo]

This may be completely unimportant to the arguments being made, but keep in mind that a DNR and Euthanasia are not the sole decision of family. The patient can go against family's wishes for either topic, or make the decision without their influence. As far as that is concerned, I don't think it's right that a family member can run to court and change the patient's decision. I think that the one going through it should make the deciding choice in such a situation.

 

[MrBishop]

This may be completely unimportant to the arguments being made, but keep in mind that a DNR and Euthanasia are not the sole decision of family. The patient can go against family's wishes for either topic, or make the decision without their influence. As far as that is concerned, I don't think it's right that a family member can run to court and change the patient's decision. I think that the one going through it should make the deciding choice in such a situation.

Problem is that when the patient is in that situation s/he often isn't in any shape to make their own decision.

 

[Dave]

You kinda lost me for a second with your medi-speak...but I think that I'll try to catch up.


You worked in Emergency...guy comes in..major GSW. Rushed to surgery to patch up a few arteries and re-inflate his lung... get sall the nice medi-toys. A few hours later...surgery's over..family shows up with a DNR...but the guy's on life-support.

sorry about that...i lapse into that with an ease that i find startling sometimes...

DNR's are generally for people with terminal illnesses or who are very old and frail. in the scenario you presented, there are so many factors to consider. was it self inflicted? was it an accident? is the chance of recovery very good? does the patient have a terminal disease? is there someone with power of attorney?
there are too many variables in that case to be able to say what the outcome would be. sorry.

This may be completely unimportant to the arguments being made, but keep in mind that a DNR and Euthanasia are not the sole decision of family. The patient can go against family's wishes for either topic, or make the decision without their influence. As far as that is concerned, I don't think it's right that a family member can run to court and change the patient's decision. I think that the one going through it should make the deciding choice in such a situation.

true.
if someone wanted to make themselves a DNR for whatever reason, they need to discuss with a trusted family member or very close friend exactly what they want. that way, when they become incapacitated, that person can speak for them.

 

[greenfreak]

I've had to deal with this very topic too many times for patients and family members alike. I'm the executor of my parent's Living Will (what heroic measures they want taken should they be unable to make their own decisions) and I'm so very glad that they were thoughtful enough to draw those papers up. It puts all of these questions to rest. And where the answers aren't clear, I am the decider. I only wish more people would do this for their children. Providing them with clear decisions should they be incapacitated is just as important as providing them with a future.

As far as what's right and wrong in the way of DNR's vs. Euthanasia, I only dealt with this situation days ago with Rusty's grandmother so I don't feel I can comment on this right now and be partial so I'll refrain.

 

[FluerVanderloo]

Problem is that when the patient is in that situation s/he often isn't in any shape to make their own decision.

Exactly. I'm not going to get into a battle over euthanasia, but I believe that if it is a terminal illness, and they can't physically do anything on their own anymore, they shouldn't be made to suffer, and then it should be the family's decision. If the patient has a terminal illness, but claims to be suffering severe pain, and can function on their own, then it's their decision that they want to die.

Anyway, the medical legal system really sucks sometimes. Learning about it for four months sucks even worse.