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CPR/DNR

CPR/DNR. THE ETHICAL ISSUES. FEATURES TO BE CONSIDERED. REALISTIC ASSESSMENT OF BENEFITS RESTORATION OF HEARTBEAT SURVIVAL TO LEAVE HOSPITAL RETURN TO PREVIOUS OR DECENT LEVEL OF FUNCTIONING ANTICIPATION OF CRISIS --- ADVANCE DIRECTIVE DISCUSSION WITH PATIENT --- DETERMINATION OF WISHES

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CPR/DNR

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  1. CPR/DNR THE ETHICAL ISSUES

  2. FEATURES TO BE CONSIDERED • REALISTIC ASSESSMENT OF BENEFITS • RESTORATION OF HEARTBEAT • SURVIVAL TO LEAVE HOSPITAL • RETURN TO PREVIOUS OR DECENT LEVEL OF FUNCTIONING • ANTICIPATION OF CRISIS --- ADVANCE DIRECTIVE • DISCUSSION WITH PATIENT --- DETERMINATION OF WISHES • FAMILY INVOLVEMENT --- SURROGATE’S AUTHORITY • SEDUCTIONS OF TECHNOLOGY • CHANGE OF MIND

  3. DNR AND ETHICS • RELATED TO DIGNITY OF PATIENTS • HONORING AND IDENTIFYING WISHES • PATIENT’S VIEW OF LIFE, DEATH, AND “GOODS” • EXERCISE OF AUTONOMY AND PROXY DECISION MAKING THROUGH INFORMED CONSENT • PRINCIPLE OF JUSTICE • TREAT ACCORDING TO ONE’S CONDITION • COMMUNICATION ABOUT OTHER END-OF-LIFE DECISIONS • DISCUSSIONS ABOUT ADVANCE DIRECTIVES • ESTABLISH CONTINUITY OF CARE

  4. CRITERIA FOR CPR/DNR • TO PREVENT SUDDEN, UNEXPECTED DEATH • COROLLARY: DNR WHEN DEATH IS EXTENDED PROCESS AND/OR EXPECTED • PRESUMPTION IS GENERALLY IN FAVOR OF CPR UNLESS OTHERWISE INDICATED • BEST INTERESTS OF THE PATIENT • RESOURCE ALLOCATIONS (@ $2,500-$3,500) • CARDIAC ARREST OCCURS WITH EVERY DEATH

  5. DNR AND AGE • SUCCESS RATE FOR CPR IS ABOUT 33%-40% ACROSS ALL AGES AND CONDITIONS • 70% OF SURVIVORS DO NOT LEAVE THE HOSPITAL • 70-79 YEARS --- 12.4% TO DISCHARGE • 80-89 YEARS --- 10.2% TO DISCHARGE • 90+ YEARS --- O% TO DISCHARGE • PRESUMPTION FOR DNR UNLESS OTHERWISE INDICATED???

  6. DNR COMFORT CARE LAW AND ETHICS • EXPECTATION OF PROCESS OF COMMUNICATION • UTILIZES THE DYNAMICS OF INFORMED CONSENT • ACKNOWLEDGES RIGHT TO REFUSE TREATMENT • EXPLORATION OF PATIENT WISHES RELATED TO THEIR VIEWS OF LIFE AND DEATH • REINFORCES DIGNITY OF PATIENT AND RESPECT FOR AUTONOMY • RECOGNITION THAT THERE ARE LIMITS TO MEDICAL INTERVENTIONS • NO LONGER BENEFICIAL • ALLOWS FOR A PEACEFUL DEATH • CAN BEGIN CONSIDERATION OF COMPREHENSIVE AND SPECIFIC ADVANCE DIRECTIVES • ARTICULATE THE VALUE CONTEXT OF PATIENT • SELECT DIRECTIONS IN TREATMENT CONSISTENT WITH PATIENT’S VALUE CONTEXT

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