Do patients with DNR orders belong in intensive care if there is a bed shortage? How would you make the decision as to who stays and who goes? Would you use medical utility, social utility, or an egalitarian first come, first served?
Ans) A small but significant percentage of ICU patients are designated DNR at some time during their ICU stay. DNR patients in the ICU are more ill, use more resources (including nursing care) and have a higher mortality rate than non-DNR patients. In an age of a critical care nursing shortage, spiraling health costs, and an emphasis on the just allocation and use of scarce resources, the question whether DNR patients should be excluded from the ICU is appropriately raised. After examination, a model policy to exclude DNR patients from the ICU was rejected because a policy excluding DNR patients from the ICU would have adverse effects on patient autonomy, beneficence, the nurse-patient relationship and fidelity, and the practice of writing DNR orders. Furthermore, such a policy would not resolve triage problems. DNR patients can appropriately be given curative or palliative treatment in an ICU when their treatment goals are reasonable and the treatment can only be given in the ICU. Conversely, DNR patients do not belong in the ICU when their treatment goals are inappropriate or when their treatment could be received on another unit. "Appropriate" and "inappropriate" treatment was not thoroughly examined except to define them in relation to Young's "point Z," the theoretical point on a life-death continuum at which one stops prolonging life and instead prolongs death. In this authors' opinion, beyond point Z, only palliative treatment is justified in the ICU. DNR patients beyond point Z should not receive curative treatments in the ICU. Many DNR patients fitting this description remain in ICUs, however, perhaps because of physician reluctance to withdraw or withhold life-sustaining treatments.
- Rationing of health care is necessary, unavoidable, and ethically complex. The levels at which health care is rationed, and the transparency of rationing, are important structural considerations in creating a sustainable and just health-care system. Ethical rationing requires deliberate choices guided by reasonably applied principles and fair procedures. How rationing occurs is important because it not only affects individual lives but also expresses what values are most important to society. We live in a world in which need is boundless but resources are not—and medicine is not immune to the consequences of this reality.
Do patients with DNR orders belong in intensive care if there is a bed shortage? How...
You have a 4-bed intensive care unit and 7 patients who need a bed. The following are the 7 patients. You cannot select on the basis of first come, first served, as they showed up at your door at exactly the same time.: 1. Mr. Jones, a 75-year-old patient with chronic emphysema. He is retired and a DNR order. 2. Mr. Smith, a 27-year-old hemophiliac with AIDS contracted from a transfusion of contaminated blood. 3. Mr. Jackson, a 65-year-old Army general with congestive heart...
You have a four-bed intensive care unit and seven patients who need a bed. The following is a short description of the seven patients. You cannot select on the basis of first come, first served, as they showed up at your door at exactly the same time. Jones, a 75-year-old pulmonary patient with chronic emphysema. He is retired and has a DNR order. Cho, a 27-year-old hemophiliac patient with AIDS contracted from a transfusion of contaminated blood. Rogers, a 65-year-old...
You have a four-bed intensive care unit and seven patients who need a bed. The following is a short description of the seven patients. You cannot select on the basis of first come, first served, as they showed up at your door at exactly the same time. Jones, a 75-year-old pulmonary patient with chronic emphysema. He is retired and has a DNR order. Cho, a 27-year-old hemophiliac patient with AIDS contracted from a transfusion of contaminated blood. Rogers, a 65-year-old...
You have a four-bed intensive care unit and seven patients who need a bed. The following is a short description of the seven patients. You cannot select on the basis of first-come, first-served, as they showed up at your door at exactly the same time. Jones, a 75-year-old pulmonary patient with chronic emphysema. He is retired and has a DNR order. Cho, a 27-year-old hemophiliac patient with AIDS contracted from a transfusion of contaminated blood. Rogers, a 65-year-old retired general...
You have a four-bed intensive care unit and seven patients who need a bed. The following is a short description of the seven patients. You cannot select on the basis of first-come, first-served, as they showed up at your door at exactly the same time. Jones, a 75-year-old pulmonary patient with chronic emphysema. He is retired and has a DNR order. Cho, a 27-year-old hemophiliac patient with AIDS contracted from a transfusion of contaminated blood. Rogers, a 65-year-old retired general...
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