Ethical Dilemmas in Healthcare: A Case Study on DNR and Patient Rights

This case study presents an ethical dilemma in healthcare involving a patient who attempted suicide and had previously signed a DNR order. The patient, an 89-year-old man, suffered a self-inflicted gunshot wound and was in critical condition. The core ethical issue revolves around whether to proceed with surgery despite the DNR order, considering the patient's mental state and the family's insistence on treatment. The case explores the legal and ethical implications of patient consent, particularly when the patient's capacity to consent is questionable due to depression and suicidal ideation. The study highlights the conflict between respecting patient autonomy, as expressed in the DNR order, and the principle of beneficence, which might suggest overriding the DNR to save the patient's life. The analysis considers relevant legal regulations, the role of healthcare professionals, and the importance of considering the patient's best interests in ethically challenging situations. The conclusion supports honoring the family's wishes since the patient was not in a sound mind when signing the DNR and committed suicide.

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Case Study
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In the present case, the patient had suffered a Gun Shot Wound to the head which was
self-inflected, and his condition was critical as understood by the vital signs of HR 121, B/P
60/45, Saturation 93%. In addition, the patient had earlier expressed his lack of desire to live
after the death of his wife. Though the neurosurgeon pointed out the chances of patient
recovery was negligible given the old age of 89 years, the patient’s family members insisted
on completing the surgery. It was evident that the patient had attempted self-harm owing to
his unstable mental condition. The ethical issue, in this case, relates to the dilemma of
whether to procced with the surgery without the informed consent of the patient. While the
provision of care for patient reporting to the emergency room with the critical condition is
mandatory, the dilemma lies in whether to proceed without the informed consent. This is of
much significance since the chances for the patient to not give the consent is more as he had
attempted suicide owing to depression after his wife’s death (Baird, 2015). Patient consent
forms an important element of healthcare delivery across the globe, including the US, where
there is stringent legal regulation concerning patient consent. The law covers the legal aspect
of the right of the patient to agree or disagree with the treatment supposed to be given to him
(Tingle & Cribb, 2013).
As the patient was taken to the ER for surgery, it was brought to notice that the patient
had signed DNR order two days back. As a nurse, the ethical and legal issue faced relates to
whether to proceed with the surgery in spite of knowing that the patient had signed DNR
orders. DNR, or ‘Do Not Resuscitate’, also known as ‘allow natural death’ is a legal order
provided to withhold cardiopulmonary resuscitation (CPR) or Advanced cardiac life support
(ACLS) as per a patient’s preference to end his life. The request for DNR under normal
circumstances is made by the patient himself and entails the health care professional
entrusted with the care of the patient to respect the decision taken by the patient regarding the
end of life. It is to be noted that a DNR has no affect on any form of treatment other than

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those requiring intubation or CPR (Griffith & Tengnah 2017). In the US, advanced cardiac
life support and CPR are not allowed to be undertaken if there is the presence of a valid
DNR. In the present case, the patient had been in intubation.
While respecting the patient’s wishes is one priority, consent of the patient’s family to
carry out the surgery cannot be ignored. The patient was not in sound mind when he signed
the DNR, as he had expressed his heartbreak after the loss of his wife. It is evident that the
patient had no desire to live and was suffering from depression. In my opinion, the
appropriate step would be to honour the wishes of his family since the patient was not in
sound mind when signing the DNR and committed suicide. According to Bartlett (2015),
ethical dilemmas are evident when a patient signing a DNR attempts to end his life by
suicide, and the treatment needs CPR or ventilation. In such a case, the principle of
beneficence gets more importance than patient autonomy, and the healthcare professional has
the right to revoke the DNR.

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References
Baird, A. G. (2015). Patient consent and opting-out. Br J Gen Pract, 65(640), 574-574.
Bartlett, L. S. (2015). Do-not-resuscitate. Nursing2017 Critical Care, 10(3), 44-47.
Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning
Matters.
Tingle, J., & Cribb, A. (Eds.). (2013). Nursing law and ethics. John Wiley & Sons.