The DNR decision--Part II. Ethical principles and application.

The medical literature presents conflicting messages and nonspecific guidelines regarding the DNR decision. Ethical principles address the questions: who should decide and for whom? Most sources acknowledge the competent patient's right to refuse treatment, but there is less agreement about resuscitating patients unlikely to recover from the underlying illness. The principles of nonmaleficence and paternalism come into play when the physician's professional duties to prevent suffering and to provide "death with dignity" begins to conflict with the patient's autonomy. Competent adults have the right to participate in decisions regarding their care. Whether this right includes the right to demand as well as refuse certain treatments is not clear. For physicians who institute DNR status without the patient's or family's consent, paternalism and professionalism have overridden patient autonomy. In that case, nonmaleficence is the basis of the physician's view of CPR as a harmful burden.(ABSTRACT TRUNCATED AT 250 WORDS)