PHE 435 Prescott College Do Not Attempt Resuscitation Policy Discussion

Description

In the assigned readings, a major focus was the need for institutions/agencies to establish policies that adequately addressed a pressing problem/dilemma/concern. In some cases, these organizations were compelled to develop policies due to perceived violations to the rights and welfare of patients, proxies, and society.
What components would a policy need to contain to support an Ethics of the Good? Please note, I am not asking you to develop an entirely new policy, just identify the necessary components. You can use a sample topic to provide background (ex. DNR, needle exchange, etc.).

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PHHE 435/535 Ethical Decision Making for Health Professionals Module 8A Cardiopulmonary Resuscitation Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois University. All Rights Reserved. Objectives • Will be able to identify important terms used in CPR • Describe the history/effectiveness of resuscitation efforts • Discuss the efforts to restrict its unconditional use • Describe the development of institutional policies for not attempting CPR • Identify major ethical concerns 1 CPR Procedures 1. Establish unresponsiveness and call for help 2. Check for breathing 3. Open the airway Photo Credit: U.S. Naval Forces Central 4. Begin basic rescue breathing CPR Procedures 5. Check for pulse 6. If pulse is present – rescue breathe only Photo Credit: Army Medicine 7. If pulse is absent – perform chest compressions CPR Procedures • Efforts often fail to revive patient • May leave patient with extensive brain damage resulting from lack of blood to brain 2 Under what circumstances should CPR not be administered? • Terminal patient – hospice • Might cause more harm than benefit – frail and old Not reasonable http://www.fractal.org/Fractal‐Research‐and‐Products/Dissecting‐Fractals_bestanden/dissecting_lungs.jpeg Rationale for CPR • “Attempting” CPR • Often fails to prevent death • Survivor may sustain harm 3 Rationale for CPR Photo Credit: U.S. Army Africa • The provision of relevant medical information may affect how family responds to requests about CPR History of CPR • Its application in surgery Operating & Recovery Rooms Emergency & Intensive Care Rooms Throughout the Institution History of CPR • Team must respond very quickly 4 History of CPR • Coding (attempting CPR) • No Code (no attempt) History of CPR • CPR became widespread emergency treatment http://salempress.com/store/images/editorial/cpr.jpg History of CPR • Number of successful efforts is not very encouraging 5 History of CPR • Outcomes of Cardiopulmonary Resuscitation in the Elderly – Ann Intern Med 1989 Aug 1;111(3):199-205 – Murphy DJ; Murray AM; Robinson BE; Campion EW History of CPR • CONCLUSION: – Cardiopulmonary resuscitation is rarely effective for elderly patients with cardiopulmonary arrests that are either out-ofhospital, un-witnessed, or associated with a systole or electromechanical dissociation. History of CPR • 1983 – 14% of those who coded were discharged • 1988 – 6% of those who coded were discharged 6 History of CPR • Questioned whether it was good clinical practice for emergency department personnel to attempt CPR when arrest occurred outside hospital History of CPR • 1/3 successful CPR that occur in hospitals • Not all of these who are successful will be able to be discharged Questions • Is it reasonable to initiate CPR when it: – Often fails – Brings additional burdens to patient • Does it make sense? 7 Questions • Should patients/family members be informed of these statistics? http://www.marinalibrary.com/Images/manthinking.gif Questions • What happens when you ask patients over 60 if they would want CPR attempted? • What happens when you inform them of the survival rates? http://www.news.com.au/common/imagedata/0,,5694282,00.jpg Questions 41% 22% 8 Questions • Would you want CPR if had a life expectancy of years Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness 3 Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness • Likely to have arrest Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness • Likely to have arrest • MD believes patient not want CPR 4 Policy Example • Informed Consent Photo Credit: Seattle Municipal Archives – Assist patients in reaching an informed decision about CPR Policy Example • Informed Consent Photo Credit: 807th Medical Command – MD writes DNR order in medical chart after getting informed consent – May issue DNR order w/o IC under what condition? – Must write down reason for Policy Example • Informed Consent Photo Credit: Save the Dream – Minors (

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