Legal and Ethics: Analysis of Not for Resuscitation Order in a Case Study

This essay analyses the legal and ethical issues relating to Not for Resuscitation order by evaluating a case study. It evaluates the four ethical principles of Beauchamp and Childress to provide advice to the family of Dawn.

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LEGAL AND ETHICS 1
Analysis of legal and ethical issues relating to Not for Resuscitation by
evaluating a case study
Medical professionals take an oath that they did not harm any people or breach the sanctity of human
life by purposely killing a person. They are expected to do whether in their power to ensure they save
the life of a patient. The ethical codes of medical field deal with common elements which include
honesty, respect for patient autonomy, respect for the law, non-maleficence, confidentiality,
beneficence and distributive justice (Percival, 2014). Ethical dilemmas in medical field arise when
there is a conflict between two ethical principles. Euthanasia is referred to the killing of a patient in
order to relieve him from the pain which he/she is suffering from an injury or disease which cannot be
treated by medical professionals. This concept has caused many controversies in the medical field
because there are a number of ethical and legal issues relating to the same. The concept contravenes
the principle of resuscitation which is referred to a process of reviving a person’s life especially from
apparent death or from unconsciousness. The advancement in the medical field has increased
recoverability from untreatable conditions, for example, cardiopulmonary resuscitation (CPR). Not for
resuscitation (NFR) or do not resuscitation (DNR) is referred to an order which prohibits a medical
professional from performing CPR on an individual (Mentzelopoulos, Haywood, Cariou, Mantzanas
& Bossaert, 2016). The thesis contributes to debates regarding ‘Not for Resuscitation’ order by
evaluating different legal and ethical issues with the same and understanding its importance to save a
person from suffering. This essay will provide different arguments regarding the legal and ethical
issues relating to NFR and critically analyse its principles to provide advice in the given case study.
This essay will evaluate the four ethical principles of Beauchamp and Childress to provide advice to
the family of Dawn.
Based on the principle of autonomy, an order for NFR should be valid because its motive is to stop
the suffering of a person. But, a medical professional takes an oath to protect the lives of others and
not to cause any harm to another individual. However, as per the American College of Emergency
Physicians (ACEP), the medical professionals are not obligated to provide treatment to a person who
will not have any realistic medical benefit by the treatment (Marco, 2005). It means that if the medical
professional is certain that the treatment will not assist in improving the health of a person than he/she
did not have to provide such treatment. In particular, while deciding on euthanasia, the party has to
consider the legal and ethical issues. The principle of autonomy provides that a patient has the
independence to determine the direction which he/she decides to take as long as he/she has his legal
rights. Ethically, a patient should be treated autonomous, and he had the right to voluntarily select the
treatment and procedures which include life support and euthanasia, but it is important that the person
must make his/her wish known even if the family members oppose it (Albtoosh & Mrayyan, 2014). In

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this case, Bronwyn told that Dawn mentioned her that she did not want to live like a vegetable for the
rest of his life and she would rather die in comfort than living in suffering for a long time. As per the
ethical principle of autonomy, an order for NFR can be issued in this case because Dawn make her
wish known and the opposition of her family does not matter. Thus, an order for NFR is an ethical
decision for the medical professionals in this case.
In case the medical professionals believe that there is not proper palliative care available which is able
to cure the patient than they can consider euthanasia in order to ensure that the patient is not suffering
from pain. The concept of euthanasia has become popular based on the concept that people have the
right to decide whether or not they should live or not. It has been argued that euthanasia is not
necessary in case appropriate palliative care is available for a patient and he/she can relive his/her
pain by taking medicine (Coombs & Grech, 2016). However, if the disease or injury is untreatable,
then an order for euthanasia is ethical especially if the patient is suffering from pain. The ethical or
moral theory obligates a medical professional to know what is best for the welfare of others which
include eliminating harm to another party by taking the decision which is in the best interest of the
patient. The principle of beneficence applies in the case when a person in permanent vegetative state
and the life support is not long for the best benefit for the patient. By keeping the patient’s best
interest in mind, the doctor decided to end the suffering of the patient through euthanasia because it is
the right or moral thing to do at such moment (Cameron-Taylor, 2014). Preventing or reducing the
suffering of a person is considered as an act of mercy and beneficence. In the case of Dawn, her
doctor has clearly mentioned that she is in a permanent vegetable state and she is suffering from a lot
of pain as well. The nurse mentioned to the family that the hospital will ask advice from an
independent medical expert or the family can appoint a doctor themselves to get a second opinion on
the situation of Dawn. Based on such opinion, the family should take the right decision which is in the
best interest of Dawn. Therefore, it can be concluded that according to the doctor, removing the life
support of Dawn will be more beneficial for her and it will be an act of mercy and beneficence.
It is argued that the actions of a medical professional must be non-maleficence and euthanasia could
be considered as maleficence but if its purpose to prevent the pain of an individual, then it is
considered as non-maleficence. The oath which is taken by medical professionals is considered as
Hippocratic Oath because it provides that a physician should treat a person to the best of one’s ability
and preserves a person’s privacy and above all, do not harm (Levinson, Ho, Mills, Kelly, Gellie &
Rouse, 2017). However, an ethical dilemma arises when a patient is suffering from an untreatable
disease or injury, and the medical professional knows that the life support system is no longer useful
and the patient will be in a vegetable stage for his whole life. The theory of non-maleficence forbids a
medical professional from inflicting any evil or harm on another person, and it is his/her obligation to
protect people from harm. Based on this theory, the doctor should do whatever in his power to treat

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his/her patients to the best of his/her knowledge. But, when treatment becomes useless or ineffective,
it resulted in causing more harm to the patient then saving his life. Even successful resuscitation cause
severe damages to the lungs, brain or heart of the patient due to which the death could occur in a
matter of hours or days (Gulacti & Lok, 2016). Similarly, the patient who is in permanent vegetable
stage might suffer from more pain when he/she is on the life support. Therefore, in order to avoid
such pain and making it more comfortable for the patient, the doctors choose the route of euthanasia.
In the case of Dawn, the doctor has clearly stated that her condition will not improve in the future at
all. Currently, she is also suffering from substantial pain which makes the life very uncomfortable for
her. If the doctor keeps her on the life support, then she is more likely to suffer from such pain for a
long time. The opinion of an independent doctor will also be considered in the case before taking any
decision. Based on which the decision of the doctor is non-maleficence, and it is the right decision for
Dawn as it is her right as given in the judgement of In re Quinlan (70 N.J. 10, 355 A.2d 647 (NJ
1976)) (Dunn, 2015).
The decision of NFR or DNR should be focused for the justice of the patient that means that the
decision should be just and fair for him in the particular situation. While deciding another person’s
life, it is necessary to ensure that the decision is just and fair and for the benefit of the party.
Similarly, the decision of euthanasia should not be based on any malice or deceptive action which
could negatively affect the patient (Mickiewicz, Krajewska, Kulak & Lewko, 2012). While deciding
whether an order for NFR or DNR should be issued, the principle of justice is must element without
which a decision for euthanasia is illegal. In Australia, euthanasia is illegal under the federal law
however many states have legalised euthanasia after evaluating the circumstance to evaluate whether
it is just to the patient. In the judgement of Cruzan v Director Missouri Department of Health, 497
U.S. 261 case, the court provided that it is unjust to accept euthanasia, especially in the case when
there is lack of evidence available to make a proper judgement (Maillet, Schwartz & Posthauer,
2013). Based on lack of evidence an application for euthanasia cannot be accepted, and it is
considered as unjust. The concept of justice emphasises equality and fairness among people. The
medical professionals are required to ensure that they did not make any discrimination between
patients based on any factors and they should be fair while giving them treatment (Green, 2014). In
the case of Dawn, the doctor has provided that she will be in a permanent vegetative state for the rest
of her life and she is also suffering from a lot a pain. She had told her daughter that rather than living
like a vegetable for the rest of her life, she would rather prefer to die comfortably. Furthermore, the
doctor believes that there is no treatment available for Dawn and she will be like this for the rest of
her life. The medical professionals believe that removing her from life support will be merciful and
beneficence for her because it will avoid the pain that she is suffering and make her more
comfortable. The doctor is also ready to hear a second opinion of an independent doctor to ensure that
the decision of euthanasia is suitable for Dawn; therefore, the actions of doctor are non-maleficence.

LEGAL AND ETHICS 4
Thus, based on these factors, it is just and fair to remove dawn for life support because it will avoid
her pain and make her more comfortable.
In conclusion, there are a number of legal and ethical issues relating to accepting an order of ‘Not for
Resuscitation’; however, it is justified if its purpose is to end the suffering of the patient. There are a
number of ethical principles which are necessary to be considered in a particular case in order to
accept the order of ‘Not for Resuscitation’. The autonomy of the patient is a key factor because he/she
has the right to decide whether or not the life support system should be removed or not. The element
of beneficence is important which means that the doctors must decide by considering the best interest
of the patient. The decision must be based on non-maleficence, and the purpose of the decision should
be to end the suffering of the patient. Furthermore, the decision of euthanasia should be based on the
principle of justice which means it must be just and fair for the patient. In the case of Dawn, she had
told her daughter that she would rather die in comfortable than live like a vegetable. The doctor is
acting for the benefit of Dawn and in order to end her suffering. The nurse will consider the opinion
of an independent doctor in order to ensure that the decision is non-maleficence. Based on these
factors, if the doctors suggest that euthanasia is right for Dawn, then her family should accept their
decision because it is just and fair for Dawn.

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References
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