Payne, Judith
March 2007
Oncology Nursing Forum;Mar2007, Vol. 34 Issue 2, p545
Academic Journal
Advances in medical technology have created a new relationship between medicine and society. Decisions about resuscitation and other life-sustaining treatments, once intensely private, have become matters of public debate and community concern. It is no longer clear whether all available technology must be used to preserve life. Rather, in light of the increasing array of technologies to extend life, society has become more concerned about the individual's right to determine how that technology will be used. The uncertainty, confusion and general lack of knowledge about do not resuscitate (DNR) orders and advance directives has created a slippery slope for all, and especially difficult for those in oncology. The purpose of this presentation is to provide an overview of the history of DNR orders and advance directives, and examine the clinical implications for nursing practice. The theoretical framework guiding this paper are components from ethical and legal doctrines and from the conceptualization of self-determination. A synthesized review of relevant literature provided a historical overview of DNR orders and advance directives. A review of legal doctrines, pertinent guidelines, and professional position papers currently guiding clinical decision making regarding these sensitive issues will be presented. A review of papers in the rare documents section of a university-based library and literature related to DNR and advance directives was conducted. Examination of historical and current documents provided an evaluative measure of how these concepts developed, reflect current practice, and how they influence our clinical decision making and education efforts today. The development of new technologies has made it increasingly clear that medical choices involve moral choices. The need to balance competing values in our delivery of care often gives rise to conflict and uncertainty. This uncertainty is heightened by limited, and sometimes conflicting, information from legal and ethical scholars in a field where technological advances increase faster than legal precedents. Since the legal process is often not well-suited to respond to urgent clinical decisions about individual medical treatments, it is imperative that nurses and physicians develop a process whereby these decisions will be handled effectively and timely.


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