Question

what is the ethical delima if patient have DNR however pregnant during time of accident 8 weeks?

Answer 1

DNR ( DO NOT RESUSCITATE) / NO CODE / ALLOW NATURAL DEATH is a legal or physician order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation ( CPR) or advanced cardiac life support ( ACLS) in the event the patient's heart stop breathing or the patient stops breathing.

ETHICAL CONSIDERATIONS: This presents an ethical dilemma and also have a fetus ( 8 weeks pregnancy) involved in this case. The burden of treatment for the patient includes the ventilator, sedation and complications of the ventilator treatment.

A) The law states that, " unless the ( patient) expressly delegates such authority to the surrogate in writing or a surrogate or proxy has sought and received court approval... a surrogate or a proxy may not provide consent for... withholding or withdrawing life-prolonging support from a pregnant patient is considered to be viability." Therefore, the patient cannot be withdrawn from the life support unless and until the fetus is able to live outside the mother's womb or unless and until a court order is obtained.

B) Furthermore, a spouse is higher in priority than other family members for acting as a proxy for the patient. According to the law, 'the proxy has the right to make healthcare decisions and based on his decision, the proxy reasonably believes the patient would have made under the circumstances". In this case, the patient's husband can act as proxy to his wife. Therefore, the healthcare team should honor the decision taken by the proxy.

C) Another law states that, " a proxy's decision to withhold or withdraw life-prolonging procedure must be supported by clear and convincing evidence that the decision would have been the one the patient would have chosen or, if there is no indication of what the patient would have chosen, then the decision is in the patient's best interest". Therefore, even if the withdrawal or the ventilator was an option, a determination should be made that this is what the patient would have wanted.

D) Another law provides that " the patient's family may seek expedited judicial intervention if they believe the husband's proxy decision is not in accord with the patient's desire or is contrary to the law". Unless and until they receive intervention and subsequent order from the court, the healthcare team should continue to follow the treatment according to the husband's proxy decisions.