Assisted Suicide vs. "Do Not Resuscitate"
#1
Greetings all!  I'd like to thank you for your prayers in the wake of my grandmother's death.

However, her situation has caused a question to crop up in my head.  We all know that Assisted Suicide/Euthanasia is a sin, but what about a "Do Not Resuscitate" request?  In the modern age, when we have the capacity to bring people back from the brink (and often from over the brink), is such a request tantamount to assisted suicide?
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#2
No, it isn't. I should think bringing someone back from death would be more ethically troubling, actually.
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#3
If one is starting to resuscitate, giving up when there is still hope would be improper, but starting it is not required. It is one thing to stop bleeding, set bones, provide shelter, prevent/treat infection, etc and it is another to actively start the processes of life. Clearing the airway, allowing for breathing and removing someone from danger is appropriate/necessary, but starting the metabolic processes, I don't think so.

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#4
There is nothing wrong with a DNR.  There are various levels a family or pt can choose and it does not change the level of care until a cardiac event or the stoppage of breathing (depending on if you choose a limited code or a complete DNR.


I think it is wise for the very old to go DNR.


If you code you have a very low chance of survival in the first place, and of those that do survive the initial code almost none make it out of the hospital! --  That does leave some hope...but for the very old they will lose every rib during compressions...it's just not worth it in most cases.  If you're thaa old make your peace with God and go home.


You will find most RNs do not want extrodinary measures in most cases because the interventions are not pleasant.
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#5
(07-25-2009, 11:38 PM)Rosarium Wrote: If one is starting to resuscitate, giving up when there is still hope would be improper, but starting it is not required. It is one thing to stop bleeding, set bones, provide shelter, prevent/treat infection, etc and it is another to actively start the processes of life. Clearing the airway, allowing for breathing and removing someone from danger is appropriate/necessary, but starting the metabolic processes, I don't think so.

What is the ethical difference between stopping an unnecessary intervention and not starting it in the first place?
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#6
(07-25-2009, 11:58 PM)SmileBugMK Wrote:
(07-25-2009, 11:38 PM)Rosarium Wrote: If one is starting to resuscitate, giving up when there is still hope would be improper, but starting it is not required. It is one thing to stop bleeding, set bones, provide shelter, prevent/treat infection, etc and it is another to actively start the processes of life. Clearing the airway, allowing for breathing and removing someone from danger is appropriate/necessary, but starting the metabolic processes, I don't think so.

What is the ethical difference between stopping an unnecessary intervention and not starting it in the first place?

Church-wise?  I'm not sure.

Legally, though, I was told in CPR class that morally you have a choice to start, but once you do start CPR you can't stop until a) someone like a doctor or EMT shows up to take over b) someone else who is certified takes over or c) you are basically about to collapse from exaustion.  Apparently, you don't get to give up because you think the person is dead, won't make it, etc.  Not unless you are a doctor, etc.
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#7
(07-27-2009, 04:13 AM)OCLittleFlower Wrote:
(07-25-2009, 11:58 PM)SmileBugMK Wrote:
(07-25-2009, 11:38 PM)Rosarium Wrote: If one is starting to resuscitate, giving up when there is still hope would be improper, but starting it is not required. It is one thing to stop bleeding, set bones, provide shelter, prevent/treat infection, etc and it is another to actively start the processes of life. Clearing the airway, allowing for breathing and removing someone from danger is appropriate/necessary, but starting the metabolic processes, I don't think so.

What is the ethical difference between stopping an unnecessary intervention and not starting it in the first place?

Church-wise?  I'm not sure.

Legally, though, I was told in CPR class that morally you have a choice to start, but once you do start CPR you can't stop until a) someone like a doctor or EMT shows up to take over b) someone else who is certified takes over or c) you are basically about to collapse from exaustion.  Apparently, you don't get to give up because you think the person is dead, won't make it, etc.  Not unless you are a doctor, etc.

As with any moral issue that is also death-defining (like this case), the legalistic gets in the way of the moralistic judgement. What is deemed 'unnecessary' and when is it deemed a moral issue? Even asking the question itself is difficult!
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#8
iggyting Wrote:As with any moral issue that is also death-defining (like this case), the legalistic gets in the way of the moralistic judgement. What is deemed 'unnecessary' and when is it deemed a moral issue? Even asking the question itself is difficult!

Ok, maybe an example or two would be useful. "Unnecessary" would be any futile intervention and/or "extraordinary care" as defined by the Church.  If a person is put on a ventilator, and it subsequently becomes clear that recovery is not possible, and the machine is the only thing keeping them alive, it's acceptable to remove the ventilator, even though it will directly cause their death.  Ventilators fall under the definition of "extraordinary care" which we are not ethically bound to provide.  Even a feeding tube can become unnecessary when the person is truly toward the end of the natural dying process, because the body is not absorbing any nutrition and the presence of the tube and undigestible food causes the person discomfort and is a possible avenue for infection.  A lot of people are uncomfortable with removal of feeding tubes, especially after the horrible Terri Schiavo case (She was NOT dying), which is understandable, especially if they still hope that the person might turn around.  Removal of a feeding tube in cases like this is a capitulation to the coming death, not the cause of it.

With CPR, I would think that morally the same principles apply.  If a DNR order is acceptable to the Church, then CPR must be "extraordinary care," and as such we can refuse it without any sort of sin, or stop it if we've already begun.  As LittleFlower said, however, we would be bound by U. S. law if we decided to start CPR.  So stopping CPR could be a sin for obeying a legitimate law, but not against the Fifth Commandment.
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#9
(07-25-2009, 07:56 PM)Pilgrim Wrote: Greetings all!  I'd like to thank you for your prayers in the wake of my grandmother's death.

However, her situation has caused a question to crop up in my head.  We all know that Assisted Suicide/Euthanasia is a sin, but what about a "Do Not Resuscitate" request?  In the modern age, when we have the capacity to bring people back from the brink (and often from over the brink), is such a request tantamount to assisted suicide?
Assisted suicide (or unassisted, even) is making a living being dead.
DNR means leaving a dead being dead.

There is no comparison. Doing something bad is not the same as not doing something good.

Simplified example:
Bad: slam door in front of person following with arms full.
Good: Hold door open for person following with arms full.
Not doing good: letting door close of its own accord, allowing person following with arms full to get a foot in before it closes
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#10
Back to the OP : whether a DNR request amounts to the sin of Assisted Suicide (AS).

IMO, and for the purpose of discussion in this forum, the moral issue is implicit in the DNR request itself. Assuming the request is done without ulterior motive, only than to allow nature to take its course, then, I think, it is not a sin. It is not against the Natural Law to follow reason to a logical conclusion after weighing the medical evidences at hand, the condition of and in the situation, not only of the patient but the concerned party (especially the family) as well. In other words, the decision making process at arriving at a DNR request is of moral consequence. Some of the difficult questions in this quest is not in the medical but in the parties to the decision, Should it be a majority view? Should the patient's wish be respected, even though he/she is not in a proper state to decide? If the patient has entered a personal directive a priori, then the moral issue is out of your hand. I believe the conclusion is always a balance of contingency, never an easy one. Having decided to go DNR, it is better not to allow our emotions to interfere in the ending. Emotion cannot be in a moral issue which deals with the truth - love is in the will. Having gone through two personal experiences, doubts still linger. That's my input for all its worth.
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