A DNR order for an 24 week old infant

A DNR order for an 24 week old infant

Should the health care providers execute the DNR or not?

Doctors at the hospital clinical cases voluntarily submitted to the Committee. This did not study other cases related to decisions not to resuscitate, informal or received in writing, which had been taken in different hospital units. The Committee recorded in all cases studied together with their outcomes. The conclusions drawn by the consensus and expressed as recommendations to the attending physician for the patient. Then he wrote a summary of these recommendations in the patient's chart. All conclusions were based on confidential consultations with parents of children and the doctors who attended them, taking into account the primary diagnosis, medical data related to the case, complications, alternative treatments, prognosis, quality of life expected, the patient's socioeconomic status, religion and hopes of the patient or family and several ethical and legal issues.

The crucial questions of the decision not to resuscitate are how to make the right decision and who can take it. The guidelines for making such decisions vary from one hospital to another and from country to country, which may emphasize one or another model of doctor-patient relationship. This article has described the experience of Chile Calvo MacKenna Hospital, a facility which serves patients from low socioeconomic backgrounds and in which the doctor's relationship with the patient is based on a model of "weak paternalism". Sometimes this setting determines the discrepancies that arise regarding "who" takes the decision not to resuscitate, not "how" you get to take such a decision (Park, Kim & Kim, 2011). These decisions must be based on the analysis of each case and taking into account the certainty of diagnosis, the likelihood of the forecast, the various treatment alternatives, expected outcomes of treatment and the patient's opinion or, failing that, the person to represent. To take the decision not to resuscitate is necessary to be sure that treatment is futile and that the results will be unfavorable if the patient survives. The uncertainty that often accompanies these cases complicates making such decisions and, sometimes, prevents adoption.

Part of the physician's responsibility is to express an accurate diagnosis and identify therapeutic possibilities and the likelihood of the forecast. But to know for sure what is best for the patient, is needed more than medical knowledge (Grudzen, et. al., 2009). In fact, it has been questioned whether taking decisions based on knowledge of what is best for the patient is part of the legitimate role of a physician.

The quality of decisions or judgments of parents depends largely on how they understand the patient's clinical situation and their own interests, hopes and values. It is therefore essential that the child's parents are well informed and express what they think is best for your child. This is particularly difficult to guarantee in a public hospital in a developing country. Generally, parents place their trust in the expertise and advice of a doctor (Chang, Huang & Lin, ...