Sunday, 6 September 2009

Making DNR decision

The overall responsibilty for a DNR decision rest with the doctor in charge
of the patient care.However, the opinion of other members of the medical 
and nursing team, the patient and the patient's relatives should be 
considered when making the decision.
The patient in this scenario is usually terminal. you should be able to 
convey the grave prognosis and the reasons behind that.
Explain in the event of cardiopulmonary arrest , resuscitation is likely to 
be unsuccessful. explain you believe the patient be kept comfortable with 
dignity and self-esteem.explain this is in the patient best interest.
Convey that the resuscitation decision is been made by the approperiate 
health authoruties and not by patient or relatives.
Describe a clear plan of palliative management.
ethical/legal issues raised in this case:
1-respect of the patient autonomy 
2-disclosure of confidential information. in this situation, the 
doctor does need the patient's consent to discuss his illness with his 
wife or carer.
3-beneficence:duty to do good and moral obligation to do no harm.
not providing CPR would be equivlent to withdrawing life prolonging 
4-duty to act justly
5-legal aspects-detailed knowledage of medical law is not required.

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