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Free Essay on DNAR
CPR Resuscitation is defined as a set of various steps required for sustaining proper circulation of oxygenated blood to individual’s vital organs, and restoration of effective heartbeat. The majority of patients who require CPR are usually very sick and typically have conditions that without resuscitation can lead to death. It is no wonder that only a limited number of patients experience a positive outcome, which ranges from about 20% to 30%. Despite relatively poor outcomes, CPR is a standard care for patients who require it. Furthermore, it is assumed that in a situation of emergency a patient had already given consent to a CPR/resuscitation or any other medical treatment unless had previously stated an objection. Thus, one needs to understand that CPR is a unique therapy that is being applied to patients without their consent and withheld only upon the reception of their proper direction. Resuscitation is the successful outcome of an attempt to resuscitate, while the request to forgo resuscitation is called Do Not Attempt Resuscitation (DNAR) or Don’t Resuscitate (DNR), the two identical terms. One should understand that the right to request DNAR is based on the individual right to self-determination, assuming that the patient is competent and in clear mind. It is for this reason, the medical facilities always use CPR when the patient is found intoxicated or on drugs that alter thinking (cocaine, marijuana, LSD) since it is believed that the patient was not able to make a reasonable decision. One should remember that the right to have a DNAR takes precedence over the wishes of family members, children, or physician. Typically most hospitals ask the patients in advance about their preference on admission to that hospital. By the same token, certain schools accept children with the DNAR request as obtained from their parents or legal guardians.
The DNAR is based on the principles of beneficence and justice. Beneficence holds that it is the best policy for the hospital to know all the wishes of patients, while justice states that since some patients have (or had) an opportunity to request DNAR, all other patients should be given the right for a DNAR. So, on one hand the children and their legal guardians who are responsible for these children should be given an opportunity to request a DNAR. On the other hand, while at school or any other educational institution, a school nurse is the person responsible for the children’s health. In the past, the schools that granted DNAR orders were exposed to law suits from the legal guardians and parents, thus putting the whole educational institution at risk.
Our school does not grant the DNAR orders and I personally believe that the DNAR orders should not be granted to children who are in schools simple because there are too many factors to account for and there are too many risks for the school. First of all children that require resuscitation are typically seriously sick and probably should be managed in home settings. The other thing is that a seriously sick child can fall off the stairs or get hit by the car etc. Technically the child’s guardians requested the DNAR believing it is the best solution to the current sickness, yet the child at present needs CPR for causes other than his/her current sickness. If nurses start calling the parents, explaining them the situation, the child might die, yet if they grant the DNAR order, the parents might sue the school district. The best practice is to give CPR and other proper treatment to a child. Thus ignoring DNAR requests while the child is on school territory appears to be the best practice. Such situation was imaginary yet only one of the infinite number of situations that can and do take place on a daily basis in US schools. Granting the DNAR would expose these schools to various misinterpretations of the DNAR orders and make them vulnerable to court suits. Thus, the most effective choice is to deny DNAR requests while a child is on school territory, OR develop an extremely long contract that would account for most situations that happen and provide solutions to these situations.