Message From the President: End of Life Issues (Part 2)
Life support, in the medical field, refers to a set of therapies for preserving a patient's life when essential body systems are not functioning sufficiently to sustain life unaided. Life support therapies utilize some combination of several techniques: feeding tubes, intravenous drips, total parenteral nutrition, mechanical respiration, heart/lung bypass, urinary catheterization and dialysis. The same techniques are also used for intensive care or in some cases during surgery, though life support is employed to stabilize a patient and is typically not sufficient to allow full recovery from their condition.
The practice of artificially prolonging the life of an individual who will not recover has been proposed to be unethical.
In the United States, a do not resuscitate, or DNR, order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy; in some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease, and is designed to prevent unnecessary suffering.
Any person who does not wish to undergo life sustaining treatment deemed medically inappropriate in the event of cardiac or respiratory arrest can get a DNR order, although DNR is more commonly done when a person who has an terminal illness wishes to have a more "natural" death without painful or invasive medical procedures.
The DNR order came into being in the U.S. in the 1960s when defibrillation allowed the reversal of cardiac arrest, but this may prolong the life of the patient for only a short time.In the U.S., cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) should not be performed if a valid written "DNR" order is present. In any cases of doubt, emergency medical technicians, paramedics and other medical workers will perform as if a DNR order did not exist, as is required by law.
For the DNR to be valid there may be rules such as the use of a special form and/or additional signatures of a doctor and/or witnesses, etc. The exact rules for obtaining a DNR order, and for emergency medical personnel to accept the validity of one, vary widely according to jurisdiction. For example, in the state of Maryland, only state DNR orders are acceptable, and they require much verification, witnesses and doctor's signatures in order to be valid. In contrast, the state of Virginia allows patients to receive a DNR order with relative ease, and will accept them from most jurisdictions.
In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders. This is especially common with paramedics, who are often employed by private companies unwilling to fight a potential lawsuit.
A DNR order must be filed on a jurisdictionally recognized form. A doctor contemplating a DNR decision should make every reasonable effort to confirm a DNR status before deciding to withhold resuscitation. To be sure that their DNR request is honored, patients should make their wishes clearly known to their family, doctors, community hospitals, care homes and any other caregivers or health care providers who may be present should a cardiac arrest occur. Some jurisdictions provide for a legally sanctioned DNR notification that is clearly visible to all healthcare personnel, similar to a MedicAlert bracelet.
The specific effect of an DNR order depends on the hospital in which the incident occurs and the terms laid out in the DNR: neither cardiopulmonary resuscitation nor intubation will be performed, but treatment for infections or other treatable conditions, intravenous feeding and fluids, pain management and comfort care are generally continued.
Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting. Organs and tissues are removed in procedures similar to surgery. People of all ages may be organ and tissue donors.
There are many more donations from dead donors than by living people. The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The popularity of donations varies substantially between countries.
Organs that can be donated include the heart, intestines, kidneys, lungs, liver, pancreas, and skin. These are procured from a brain dead donor or a donor for whom the family has given consent for donation after cardiac death, known as non-heart-beating donation. The following tissues can only be procured after death --bones, tendons, corneas, heart valves, femoral veins, great saphenous veins, small saphenous veins, pericardium, and the sclera.
Organs that can be donated from living donors include part of the liver or pancreas and the kidney.