Siena College Taytay CHAPTER IX: College of Nursing WITHHOLDING AND WITHDRAWING LIFE SUPPORT

Biological and Biographical LifeI cannot but have reverence for all that is called life. I cannot but avoid compassion for all that is called life. This is the beginning and foundation of mortality. It is good to maintained and cherish life; it is evil to destroy and check life. ---Albert SchweitzerThe practitioner’s duty was to respect life and preserve it which can conflict with the duty to alleviate pain and suffering.

Brain DeathUnreceptively and unresponsivenessNo movements or breathingNo reflexesFlat EEG of confirmatory value

Persistent Vegetative States (PVS)State wherein there is irreversible loss of all neocortical function. Brain stem function remains and patients can breathe on their own.

Ordinary and Extraordinary Care Ordinary means are all medicines, treatments and operations that offer a reasonable hope of benefit

and which can be obtained without excessive expense, pain, or other inconvenience Extraordinary means are all medicines, treatments and operations that cannot be obtained or used

without excessive expense, pain, or other inconvenience or which , if used would not offer a reasonable hope of benefit.

PersonhoodCharacteristics that beings may posses in order to be considered as bearer of rights 1. One who could be said to have interests; a person for whom something can be said to be good for his or her own sake.2. One who has cognitive awareness; a being of memories, expectations, and beliefs.3. One who is capable of relationships. Interpersonal relationship seems to be at the very essence of what of what we idealize in truly being a person.4. One who has sense of futurity.

Advance DirectivesPeople who are seriously or terminally ill are more likely to have an advance directive.

Durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states that you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. But a DPA may not be a good choice if you don't have another person you trust to make these decisions for you.

Do not Resuscitate (DNR) is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 141-160.

Siena College Taytay CHAPTER IX: College of Nursing WITHHOLDING AND WITHDRAWING LIFE SUPPORT

Living will is one type of advance directive. It is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.

You can write an advance directive in several ways:Use a form provided by your doctor. Write your wishes down by yourself. Call your health department or state department on aging to get a form. Call a lawyer. Use a computer software package for legal documents.

Proxy Decision-Making StandardsParents patriae-Under this doctrine the states accepts these cases on the basis of legitimate duty, abiding in the principles of beneficence and nonmaleficence.Best-Interest Standard most often takes into account such tangible factors as harms and benefits, physical and fiscal risks.Substituted-Judgment Standard maintains that the decision about treatment or non-treatment must remain that the patient, based on the principle of autonomy. The fact that a patient is incompetent to make a decision for himself does not take from him the right to self-determination. A substitute is selected who is required to act in proxy for the patients-that is, to make the decision that the incompetent patient would have made if the patient had been competent.

DNR Orders (Do not Resuscitate)

Baby DoePhysician’s reasonable medical judgment, any of the following circumstances apply:1. The infant is chronically and irreversibly comatose.2. The provision of such treatment would merely

a. prolong dying.b. not be effective in ameliorating or correcting ALL of the infant’s life-threatening conditions.

3. The provision of such treatment would be virtually futile in terms of the survival of the infant, and the treatment itself under such circumstances would be inhumane.

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 141-160.

DNR Guidelines1. DNR orders should be documented in the written medical record2. DNR orders should specify the exact nature of the treatments to be withheld.3. Patients, when they are able, should participate in DNR decisions. Their involvement and wishes should be documented in the medical record.4. Decisions to withhold CPR should be discussed with the health care team.5. DNR status should be reviewed on a regular basis.