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10/17/2018

Unilateral DNR in 2018 (ASBH Frriday)

Join me at the Hospice and Palliative Medicine ASBH affinity group on Friday at 12:45 PM.


In light of legislation in several states, the concept of unilateral DNR in 2018 seems to be changing. New specifications regarding DNR orders are in place in Kansas, in legislation named “Simon’s Law” which applies to pediatric patients (Missouri will almost certainly have a form of Simon’s Law considered next year) and Texas in the form of SB11 which went into effect April 1. Both bills have been characterized by their supporters as patient protection legislation.


Discussion will be encouraged from participants, those who are directly affected in these states and then toward potential issues arising from statutory specifications regarding end of life care.


It would appear that, under these laws, decisions about resuscitation status and the use of life prolonging measures cannot be made without the assent/ permission of the patient or surrogate. 


Does this rob the clinician of her prerogative of employing clinical judgment?


Understanding that there are caveats in each bill and various underlying inciting events, the result appears to be that CPR, instead of being a medical procedure with indications and contraindications, is being seen as a “right” for patients. 


But isn’t it the clinician who is called, trained, licensed, and certified to discern when to employ this (and all) medical procedures?


Ethically, the principles of autonomy, beneficence, justice and non- maleficence seem to be at work. So, too, however is the necessity to explore parental/patient/family stories (narrative) and evaluate what might lie behind such demands. Relational meaning and security may also be at play feminist/care ethics). 
So, how do ethical frameworks help or hinder in these situations?
Should we entertain these demands as simply Advance Care Planning?
What about the potential erosion of trust (or presumption of distrust) which seems to be operant here?
Will potentially non-beneficial treatment be demanded? Can physicians ‘escape’ via conscientious objection clauses or recourse?
How can we [collectively] best pursue an acceptable quality of life for the patient, without harming him/her?


After a few clarifying slides and comments from Drs Richard Butin, Brian Carter and Kelstan Ellis, audience members will be asked for experiences and opinions.


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