DNR Order and Elderly

Year 2017, , 32 - 40, 28.12.2017

Burcu Çuvalcı , Sevilay Hintistan

https://doi.org/10.19127/mbsjohs.338904

Abstract

Cardiopulmonary resuscitation is a choice that must be made between the
return of life and the end of life. It is still a matter of controversy when
and where cardiopulmonary resuscitation will be implemented, and this
discussion has brought the "Do Not Resuscitate" order to the agenda.
For this reason, "Resuscitation" and "Do Not Resuscitate"
order lead to many ethical and legal dilemmas. The "Do Not
Resuscitate" order, which is a difficult decision to make, becomes more
difficult in the old age when ethical problems are frequent. Because of chronic
diseases and deterioration in cognitive functions, the ability to make
decisions about health practices of elderly individuals who are becoming
increasingly dependent in terms of physical and psychosocial dimensions are also
diminishing. In addition, lack of awareness, sensory/emotional barriers and
communication deficits prevent elderly people from participating in health care
decisions; it makes difficult to determine care target among the elderly and
health professionals. Especially to be adequate to the needs of nursing care
for the elderly, the problems related to "Do Not Resuscitate"
instruction which is an important part of end-of-life maintenance need to be
solved. For this purpose, the "Do Not Resuscitate" order should be
handled by health professionals and lawyers in a versatile manner and necessary
legal arrangements should be made.

Keywords

Elderly, Nursing, Do Not Resuscitate, DNR Order

References

• 1. Akpınar A, Ersoy N. Life-sustaining treatment: when should it be withheld or withdrawn?. Turkish Journal of Oncology 2012; 27(1):37-45.
• 2. American Heart Association requests that this document be cited as follows: Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, et all. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132(2):315-367.
• 3. American Medical Association (2016). Do-Not-Resuscitate Orders. Accessed June 20, 2016, at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion222.page.
• 4. American Nurses Association (2012). Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions. Ascessed February 21, 2016, at http://www.nursingworld.org/MainMenuCategories/EthicsStandard s/ Ethics-Position-Statements/Nursing-Care-and-Do-Not-Resuscitate-DNR-and-Allow-Natural-Death-Decisions.pdf.
• 5. Association of PeriOperative Nurses (2010). AORN position statement on perioperative care of patients with do-not-resuscitate or allow-natural-death orders. Accessed 12 February, 2016, at http://www.aorn.org/PracticeResources/ AORNPositionStatements/.
• 6. Cherniac EP. Increasing use of DNR orders in the elderly worldwide: whose choice is it? J Med Ethics 2002; 28:303-307.
• 7. Chevaux F, Gagliano M, Waeber G, Marques-Vidal P, Schwab M. Patients' characteristics associated with the decision of “do not attempt cardiopulmonary resuscitation” order in a Swiss hospital. Eur J Intern Med 2015; 26(5):311-316.
• 8. Cicekci F, Atıcı SS. The evaluation of the results of cardiopulmoner resusitation associated with code-blue. Genel Tıp Dergisi 2013; 23(3):70-76.
• 9. Fadıloğlu C. Advance directive in geriatrics. Ege Journal of Medicine 2014; 53(10):48-52.
• 10. van de Glind EM, van Munster BC, van de Wetering FT, van Delden JJ, Scholten RJ, Hooft L. Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review. BMC Geriatrics 2013; 13(1):1.
• 11. Gonenc I. Hukuki ve etik açıdan resüsitasyon. Sağlık Düşüncesi ve Tıp Kültürü Dergisi 2015; 36:50-51.
• 12. International Council of Nurses ICN (2012). Code of Ethics for Nurses. Accessed Mach 18, 2016. Available From: http://www.icn. ch/who-we-are/code-of-ethics-for-nurses/.
• 13. Karadakovan A. Yaşlı ile ilgili Sorunlar ve Politikalar. In: Yaşlı Sağlığı ve Bakım Akademisyen. 1rd ed. Ankara: Tıp Kitapevi; 2014. p.88.
• 14. Karatas M, Selçuk EB. History of the Cardiopulmonary Resuscitation. Kafkas J Med Sci 2012; 2(2):84-87.
• 15. Kellum JA, Dacey MJ (2009). Ethics in the intensive care unit: Informed consent; withholding and withdrawal of life support; and requests for futile therapies. Acessed May 10, 2016, at http://www.uptodate.com/contents/ethics-in-the-intensive-care-unit-informed-consentwith holding-and-withdrawal-of-life-support-and-requests-for-futile-therapies.
• 16. Kozacı N, Ay MO, İçme F, Aktürk A, Satar S. Are We Successful in Cardiopulmonary Resuscitation? Cukurova Med J 2013; 38(4):601-609.
• 17. Messinger-Rapport BJ, Kamel HK. Predictors of do not resuscitate orders in the nursing home. J Am Med Dir Assoc 2005; 6:18-21.
• 18. Mevzuatı Geliştirme ve Yayın Genel Müdürlüğü (1998). Hasta Hakları Yönetmeliği. Accessed June 20, 2016. Available From: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=7.5.4847&MevzuatIliski=0&sourceXmlSearch=hasta%20haklar%C4%B1.
• 19. Phillips JL, Halcomb EJ, Davidson PM. End-of-life care pathways in acute and hospice care: an integrative review. J Paın Symptom Manag 2011; 41(5):940-955.
• 20. Seder DB, Patel N, McPherson J, McMullan P, Kern KB, Unger B, Dziodzio J et al. Geriatric experience following cardiac arrest at six interventional cardiology centers in the United States 2006–2011: interplay of age, do-not-resuscitate order, and outcomes. Crit Care Med 2014; 42(2):289-295.
• 21. Sert H, Gözdemir M, Işık B. Kardiyopulmoner canlandırma yapılmaması etik mi?. Yeni Tıp Dergisi 2007; 24(2):85-9.
• 22. Sumrall WD, Mahanna E, Sabharwal V, Marshall T. Do Not Resuscitate, Anesthesia, and Perioperative Care: A Not So Clear Order. The Ochsner Journal 2016; 16(2): 176-179.
• 23. Tel H. Ethical Problems Frequently Encountered in the Intensive Care Units. Cumhuriyet Nurs J 2012; 1:30-38.
• 24. Yang GM, Kwee AK, Krishna L. Should patients and family be involved in" Do not resuscitate" decisions? Views of oncology and palliative care doctors and nurses. Indian Journal of Palliative Care 2012; 18(1):52.
• 25. Yokusoglu M, Eryilmaz M, Baysan O. Cardiopulmonary resuscitation in the view of ethics and law. Anatol J Cardiol 2008; 8(5):374.
• 26. Yüksek Sağlık Şurası 25.2.1970/ 6324, Yargıtay 4. Ceza Dairesi 28.2.1970,28.2.1945/1394.6.