sábado, 19 de marzo de 2016

Unilateral Do Not Resuscitate orders – what doctors think

Unilateral Do Not Resuscitate orders – what doctors think

Unilateral ‘do not resuscitate’ orders: what doctors think

In an article published online this week in the Journal of Medical Ethics, three US-based researchers discuss the results of a survey of neonatologists’ opinions regarding Do Not Attempt Resuscitation (DNAR) orders.

Unilateral DNAR decisions – decisions about resuscitation made by doctors without patent or surrogate consent – are highly controversial. Some see them as usurping patient autonomy.

The authors of the article are sympathetic to the view that unilateral DNAR orders are in certain circumstances ethically permissible. What’s more, they found that most American pediatricians agree with them.

The authors emailed an anonymous survey to 3000 members of the American Society of Pediatrics Section of Perinatal Medicine, and had a response rate of 16% (490 respondents).

Of those who responded, 77% said it was ethically permissible to issue a unilateral DNAR order where doctors were treating an infant for whom survival was felt impossible. 61% said it was ethically permissible when survival was felt ‘unlikely’.

Interestingly, only 51% said they would enter the order if they found themselves in such a situation. The authors attempted to explain the discrepancy between judgements of ethical permissibility and personal practice.

“The discrepancy…should also be considered in light of the professional climate in American medicine. It has been reported that physicians in the USA commonly initiate and continue treatment until it is virtually certain that the patient will die, taking a ‘waiting for near certainty’ approach to end of life.”
The physicians had a similar attitude toward patients with a poor neurological prognosis. 57% said a unilateral DNAR would be permissible if no curative treatment was available.
- See more at: http://www.bioedge.org/bioethics/unilateral-do-not-resuscitate-orders-what-doctors-think/11807#sthash.8u5oXIZ8.dpuf


Hi there,
Next week the staff of BioEdge will be celebrating Easter, so there will be no newsletter. We shall resume early in April.
This week's issue contains a familiar but still sobering story about experiments by Nazi doctors during World War II, this time with an Australian twist. In dusty archives historians have uncovered the experiences of five Australian POWs captured in May 1941 in Crete. They were infected with hepatitis by an SS physician, Dr Friedrich Meythaler, to see how the disease was transmitted. Luckily none died of the disease. 
This is just a single thread in the tapestry of World War II horrors, although of special interest to Australians. What interested me was a coda by the German historian who is writing up the story, Konrad Kwiet, of the Sydney Jewish Museum. His mother and sister were both doctors and they actually were friendly with Dr Meythaler, who eventually became an eminence in German medicine in the post-War years. His sister was utterly astonished when he told her a few months ago about Meythaler's dark past. 
There is a well-worn moral to this anecdote, but one which cannot be repeated too often. Doctors need to be firmly and unconditionally commited to the dignity of all human beings. Otherwise they can easily succumb to the temptation to exploit vulnerable men and women in the course of following orders, or even more disgracefully, to advance their careers.

Michael Cook

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Antonio Moser was a distinguished Catholic scholar
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