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Ethical Issues in Dialysis
Alan Spital, Series Editor: Do Not Resuscitate Orders and Iatrogenic Arrest During Dialysis: Should “No” Mean “No”?
Author(s) -
Ross Lainie Friedman
Publication year - 2003
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1046/j.1525-139x.2003.16081.x
Subject(s) - medicine , do not resuscitate , cardiopulmonary resuscitation , intensive care medicine , dialysis , autonomy , do not resuscitate order , documentation , hemodialysis , patient care , medical emergency , resuscitation , nursing , surgery , law , political science , computer science , programming language
An iatrogenic arrest is a cardiopulmonary arrest induced by a therapeutic effort. Frequently cardiopulmonary arrests during hemodialysis (HD) are iatrogenic. In this article I consider the question of what to do when a cardiopulmonary arrest occurs during HD in a patient with a do not resuscitate (DNR) order. I consider and reject four arguments to override the DNR order: the principle of nonmaleficence, the efficacy of resuscitation, proximate cause, and physician error. Instead, I argue that respect for patient autonomy and patient goals means that DNR orders must be respected unless there is compelling evidence that overriding the DNR would be consistent with the patient's goals. If such evidence is lacking, the physician has no moral choice but to follow the DNR order literally. As such, nephrologists need better communication with their patients regarding advance care planning and better documentation of their communication once it has occurred.