DNR policy in NY state: From a critical social theory perspective 2
DNR is a legal order to facilitate natural death or no intervention to prevent death. This is an important decision on someone’s life and reflect their wishes (ANA 2012). In New York state Nurse practitioners are allowed to sign death certificates but not allowed to enter Do Not Resuscitate order. In New York state, nurse practitioner’s scope of practice includes diagnose, treat illness and give compassionate care but not “eligible” to give end of life care (NYSOP, 2016). This also interferes the continuity of care. DNR policy in New York state is a main barrier to achieve full extent of our education and training.
Analysis of the historical, political, economic and social aspects of DNR policy in New York state.
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Health care providers were over used CPR on every patient without knowing the consequences of CPR. Studies were showed high mortality rate in post CPR patients. Then physicians were made patients DNR without telling patients or their family and nurses were placed a purple sticker on these patients charts to provide a visual cue to other health care providers. Eventually few stickers were fell off or misplaced. In 1987 New York state passed the bill that physician can write DNR order according to patient or health care proxy’s decision. In 1991, congress has passed patient self-determination act (ANA 2012). It clearly states that physicians are not allowed to enter DNR order without the permission of patient or health acre
As a result, life-sustaining procedures such as ventilators, feeding tubes, and treatments for infectious and terminal diseases are developing. While these life-sustaining methods have positively influenced modern medicine, they also inadvertently cause terminal patients extensive pain and suffering. Previous to the development of life-sustaining procedures, many people died in the care of their own home, however, today the majority of Americans take their last breath lying in a hospital bed. As the advancement of modern medicine continues, physicians and patients are going to encounter life-altering trials and tribulations. Arguably, the most controversial debate in modern medicine is the discussion of the ethical choice for physician-assisted suicide.
... middle of paper ... ... A patient having autonomy is one of the most important rights that we are given in this life. It should not be taken away because some believe that PAS is not a justifiable suicide.
...o get a do not resuscitate order. That is an order that the families may sign so the hospital does not have to give effort to bring a person back to life anymore once they have stopped breathing.
There are many legal and ethical issues when discussing the topic of physician-assisted suicide (PAS). The legal issues are those regarding numerous court cases over the past few decades, the debate over how the 14th Amendment of the United States Constitution comes into play, and the legalization vs. illegalization of this practice. The 14th Amendment states, “nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws” (U.S. Const. amend. XIV, §1). PAS in the past has been upheld as illegal due to the Equal Protection Clause of the 14th amendment of the constitution, but in recent years this same 14th amendment is also part of the reasoning for legalizing PAS, “nor shall any State deprive any person of…liberty” (U.S. Const. amend. XIV, §1). The ethical issues surrounding this topic include a patient’s autonomy and dignity and if PAS should be legalized everywhere. This paper is an analysis of the PAS debate and explores these different issues using a specific case that went to the supreme courts called Washington et al. v. Glucksberg et al.
Mr. Middleton, a journalist, compiled an article describing, in his opinion, the flaws of the Endangered Species Act. He then attempts to back his opinion with studied analyses, researched facts, and testimonies. To summarize Middleton’s (2011) perspective, “Rather than provide incentives for conservation and environmental stewardship, the Endangered Species Act punishes those whose property contains land that might be used as habitat by endangered and threatened species” (p. 79). This quote is broad and generalized yet draws in readers and forces Middleton to spend the rest of the article backing this statement with more logic based facts.
the decision to end their lives often turn to their physicians for advice. However, studies indicate that many physicians are unwilling to provide their assistance in suicide because it conflicts with their ethical beliefs and because it is illegal. The legalization of PAS is a sensitive, yet complicated, topic which is becoming more and more popular with America’s aging population and the terminally ill patients. PAS is a social issue which is here to stay. The legalization of PAS is continually being debated all over the United States and offers a potential for abuse. In 1994, PAS laws of Washington and New York were challenged in federal court and declared unconstitutional. Physician assisted suicide should not be legalized in any state.
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
The nursing profession is formed upon the Hippocratic practice of "do no harm" and an ethic of moral opposition to ending another human’s life. The Code of Ethics for nurses prohibits intentionally terminating any human life. Nurses are compelled to provide ease of suffering, comfort and ideally a death that is coherent with the values and wishes of the dying patient, however; it is essential that nurses uphold the ethical obligations of the profession and not partake in assisted suicide. (King, 2003)
It is found that nurses report that their most uncomfortable situations come with prolonging the dying process and some struggle with ethical issues by doing so (Seal, 2007). Studies have shown that implementation of the RPC program and educating nurses have increased the nurses’ confidence in discussing end-of-life plans (Austin, 2006). With confidence, the nurse is able to ask the right questions of the patient and make sure that the patient’s wishes are upheld in the manner that they had wanted, such as to not resuscitate or to make sure their spiritual leader is present when passing (Austin,
Advance directives might have many guidelines for patient’s preferences with regard to any number of life-affecting, or end of life situations, such as chronic disease or accident resulting in traumatic injury. It can include directions for other health situations, such as short-term unconsciousness, impairment by Alzheimer disease or dementia. These guidelines may consider do-not- resuscitate (DNR) orders if the heart or breathing stops, tube-feeding, or organ and tissue donation. The directive might name a specific person, or proxy, to direct care or may be very general with only basic instructions given for treatment in time of the incapacitation of a patient. Some states say that if you do not have a written directive, a spoken directive is acceptable.
In an effort to provide the standard of care for such a patient the treating physicians placed Ms. Quinlan on mechanical ventilation preserving her basic life function. Ms. Quinlan’s condition persisted in a vegetative state for an extended period of time creating the ethical dilemma of quality of life, the right to choose, the right to privacy, and the end of life decision. The Quilan family believed they had their daughter’s best interests and her own personal wishes with regard to end of life treatment. The case became complicated with regard to Karen’s long-term care from the perspective of the attending physicians, the medical community, the legal community local/state/federal case law and the catholic hospital tenants. The attending physicians believed their obligation was to preserve life but feared legal action both criminal and malpractice if they instituted end of life procedures. There was prior case law to provide guidance for legal resolution of this case. The catholic hospital in New Jersey, St. Clare’s, and Vatican stated this was going down a slippery slope to legalization of euthanasia. The case continued for 11 years and 2 months with gaining national attention. The resolution was obtained following Karen’s father being granted guardianship and ultimately made decisions on Karen’s behalf regarding future medical
Physician-assisted suicide refers to the physician acting indirectly in the death of the patient -- providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, "do no harm" principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue.
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
* Daily, Gretchen C., ed. Nature’s Services: Societal Dependence on Natural Ecosystems. Washington, D.C.: Island Press, 1997.
On the planet Earth, there is a limited space upon which life may settle. This is one of many factors that creates what is regarded by scientists as a factor in the carrying capacity of a habitat, specifically the Earth. This world has much land that is available for human settlement. However, because the exponential rate at which the human population has gone, and because the excessive needs of some people who live excessively, we have quickly reached the point at which the Earth will no longer be able to support humans. However, regardless of this shortage of land in the United States of America there is an excess of land that remains unsettled completely by man. This land is referred to often as the frontier and remains for the most part empty in comparison to the remainder of the country. However, with all of this land in the country it is necessary to manage it and to ensure that it remains kempt and in watched over. This idea of land management is known mostly in the United States. It is not known to many other places in the world mostly because most other places do not have any land that can be managed. However, in the United States we have excess lands that have been designated as public lands. These lands are preserved and kept as natural as possible for the sake of nature and its processes. Some of these lands designations are national parks, nature preserves, and other national and state preservations. These lands are managed by both federal and state agencies and programs that are to the benefit and continuation of natural lands, and unlike other countries these places do not interfere with the habitats and lives of people.