DNR vs. Selective Euthanasia

[MrBishop]

DNR – Do Not Resituate - Basically a judgement call made by the Doctor and, in some cases the family*where present*, as to what a ‘heroic measure’ is and whether it should be administered.



Euthanasia – A decision made by the family to discontinue treatments or medication to a patient who requires it to continue living, or to administer medication in order to speed along the demise of the patient. (aka Assisted Suicide in the latter case)



Here’s the point. In the case of DNR…it’s up to the doctor and the family to decide how much effort should go into saving the life of the patient….in Euthanasia, it’s discontinuing an existing effort. There’s a fine line there… at what point does an existing effort go against the DNR’s Heroic Efforts clause and become stoppable?



Morally speaking…where would you draw the line between the two? One is a legal right and one is a legal conundrum, with a slippery slope attached to it for good measure.

[inked]

Do Not Resuscitate may be a doctor judgement call in England and Canada, but in the USA this is a decision that had better be discussed and authorized with the family and patient. Basically, it means that if a life-threatening event such as a stopped heart or arrested breathing occurs, no interventions will be made to resuscitate. In generally terminal conditions with progressively poor health or response, it is the decision to terminate active interventions and allow nature to take its course, but it presupposes a natural course of the disease process and events.

Any adult patient who is mentally competent can refuse any treatment whether life-saving or not. Refusal of treatment may mean allowing the patient's disease to progress without intervention, but this is a patient decision.

Euthanasia is the deliberate killing of the ill or debilitated by a party or parties other than the patient.
Passive euthanasia is the removal of supportive measures without which the patient will die (eg, feeding tubes, IV hydration, respirators).
Active euthanasia is the deliberate introduction of a drug or stimulus to end life (lethal medications to arrest cardiac or repiratory efforts).

Suicide is the termination of an individual's life by that individual.

Heroic measures usually means the institution of mechanical or electrical supports of functions without which life will terminate (coding or resuscitation efforts, respirators, pacemakers, heart pumps, heart-lung machines, endotracheal intubation, etc).

One is best served by having an advanced directive in these matters and discussions with family about one's wishes prior to an incapacitating event. Living wills and medical power of attorney are good resources for the family in times of stress and uncertainty of outcome.

It is impossible for any document to cover every possible contingency of life and technology, but having one can go a long way toward avoiding not having your desires known and enacted.

edit:

I just realized that your wording was selective euthanasia. That is worse as it implies there are arbitrary criteria by which folk will be selected for euthanasia. That has been done before, most notably in Greece (Sparta), Germany (Third Reich), and China (male preferred over female infants). Is that what you intended?

Another rendering would be applying deliberate killing of the individual who is ill only under certain conditions. Is that what you meant?

Have you ever seen the movie SOYLENT GREEN?

[Last Child of Ungoliant]

after a point of no return there should be an automatic cut off point, i know that i would not wish to linger on in darkness and doubt whilst the slow years of the world pass me by

[Spock]

This thread is a good discussion based upon what happened in Florida, USA and with Pope John. Each situation was one of these choices. The Pope made his wishes known and was able to show dignity in death. The Fl. couple did not have any legal means in place; i.e. living will; and so it dragged on for years with neither side "winning" and the patient losing no matter how it was viewed. IMO the individuals need to have input and think ahead for the comfort and mental well being of their families and themselves. Leaving such decisions in the hands of essential strangers opens Pandora's box of moral, ethical and legal woes.

[Last Child of Ungoliant]

yes but when pandora's box gets opened, hope is left inside

[Spock]

..from the perspective of historical literature , LCOU, you are quite correct. I used the analogy as one most could relate to.

P.S. glad to see you got your flashing Che.

[MrBishop]

Originally Posted by inked

Heroic measures usually means the institution of mechanical or electrical supports of functions without which life will terminate (coding or resuscitation efforts, respirators, pacemakers, heart pumps, heart-lung machines, endotracheal intubation, etc).

Usually means...that's the crux. Using CPR on a person with a heart-attack might be considered a heroic measure. Administering a shot of adrenallin through the rib-cage and into the heart might be considered the same.

Originally Posted by inked

One is best served by having an advanced directive in these matters and discussions with family about one's wishes prior to an incapacitating event. Living wills and medical power of attorney are good resources for the family in times of stress and uncertainty of outcome.

It is impossible for any document to cover every possible contingency of life and technology, but having one can go a long way toward avoiding not having your desires known and enacted.

True enough...and that's where this thread was going. A doctor faced with a DNR in one hand and a patient with a heart-attack on the other would ahve to decide at that point, what that little card that says "Please do not resussitate" actually means. If the card is discovered after the patient has been stabalized...that card is moot.

So, what you have is patient who is alive through an extraordinary measure and being kept that way through another extraordinary measure (usually an IV drip, heart-monitor, etc...) while s/he is waiting for an operation. The family shows up...tells the hospital about the DNR. The hospital and family now have a choice. Respect the DNR/No extraordianry measures .. and basically unplug the patient (Selective Euthanasia) or wait until the patient him/herself can recover enough to have a say.

Originally Posted by inked

Another rendering would be applying deliberate killing of the individual who is ill only under certain conditions. Is that what you meant?

That's more radical than I was aiming at, but it does fall on the same slippery slope. Imagine someone in a coma, being kept alive through modern machinery. Its discovered that s/he has no family, no insurace and no money. The hospital is paying to keep a stranger alive..indefinatly. How long is the hospital responsible for keeping him/her alive?