h. Degree of Consensus Between the Surrogate and Physician. The court
attaches great weight to what the treating physician has to say about the surrogate's
decision. If the surrogate's decision is consistent with good medical practice, the court
is more likely to honor refusal of treatment. The court attaches great weight to the
physician's opinion because the physician is the person most familiar with the patient's
condition. The physician has had previous experience in making this type of decision,
and he or she is, in principle, less apt to be acting out of self-interest or bias.
i. Nature of the Surrogate's Relation to the Patient. This is the least
important of the factors. But it still plays a role when the court decides to uphold a
decision that goes beyond medical custom and practice, as in the case of Karen
Quinlan. The court looks for a close loving relationship. Any evidence of conflicting
motivations or special interests will affect the credibility of the surrogate's decision.
DO NOT RESUSCITATE ORDER
a. A Written do not resuscitate Order Required. Resuscitation is a standing
order that will be initiated unless there is a written Do Not Resuscitate (DNR) order.
The DNR order is a written order to suspend otherwise automatic initiation of
cardiopulmonary resuscitation (CPR). The only treatment suspended is CPR. The
DNR order is not a withdrawal of life support and should not affect other treatment and
efforts to provide comfort and relief from pain. A DNR order is in writing and must be
reviewed every 72 hours.
Do Not Resuscitate (DNR) order: a written order to suspend otherwise
b. Candidates for a Do Not Resuscitate Order. Potential candidates for a
DNR order are irreversibly, terminally ill patients and those in a persistent vegetative
irreversible terminal illness: a progressive disease or illness known to
terminate in death, and for which additional therapy offers no reasonable
expectation of remission.
persistent vegetative state:
a chronic state
of diminished consciousness
resulting from severe generalized brain injury, in which there is no reasonable
possibility of improvement to a cognitive (perceiving and knowing) state.
c. Competent Patients Make Own Choices. As stated earlier, under state
laws competent patients are adults or emancipated minors, who have the ability to
communicate and understand information and the ability to reason and deliberate
sufficiently well about the choices involved. A decision made while the patient is
competent will be honored if subsequent incompetence occurs, unless there is reason
to believe that the patient's choice has changed or would change. This sometimes
happens when living wills are so generally worded that there is doubt as to whether or
not certain specific medical conditions are covered by the will. Questions may also
arise if time has elapsed since the initial drafting of the will.