Ethical Issue...Living will, DNR

[Roxanita]

Q- A medical intern is treating an elderly man with end-stage cardiomyopathy. The patient had written a living will the year before, and his family is questioning whether that can be used for a DNR order since the man is now comatose?

What do you know about Living Will and DNR?

[Roxanita]

Living Wills...
Are instruments created when a patient is able to make decisions about his or her end-of-life treatment which detail what extraordinary and ordinary treatments the patient wishes to have or not have. They are legally enforceable in many jurisdictions.

When a DNR order is issued, consent to this by the patient or by whoever is determining this should be documented in the medical chart. In most jurisdictions, if the patient cannot make decisions about their DNR status, the family can use substituted judgment to issue a DNR request.
While it is best if all the relatives agree to the DNR status, the closest next-of-kin is usually given the right of decision making in this regard.

Dosages of narcotics, which may hasten death, may be appropriate for pain control if a patient is "DNR.”