Meds Sci Review

Ethical and Cultural Consideration in Majority of Asian People Using DNR Order Signed by Surrogate

Bulqis I. Sakinah

Do-not-resuscitate (DNR) order is a common term for a written statement by a licensed physician with the decision made by the patient/surrogate whether or not to perform the CPR when a cardiac and/or respiratory arrest happen (Braddock III and Clark, 1998). This protocol is used in some cases including patients who had the malignant or terminal illness that agreed to not receiving CPR when they had a cardiac arrest.

While Sasson et al. (2010) in Travers et al. (2010) stated that CPR or Cardiopulmonary resuscitation is life-saving action improving the survival rate when cardiac arrest happens. CPR was being performed to everyone in cardiac arrest situation until there were some cases found that after CPR has been given, there was a high morbidity in the patients with majority had malignant ill. Since then, DNR was born to cover the beneficence and autonomy aspects of medical ethics.

The DNR order requires quite a situation that has been ensured that the order not to resuscitate has no implication on any other treatments (Hemphill, 2007). Downar et al. (2011) argued the patients that would have a bad quality of life after CPR don’t have to undergo the CPR. So basically, the DNR order could be applied to the patients with bad prognosis after CPR or in the end-of-life treatment state of terminal illness.

Yet, the DNR order hasn’t automatically used widely for all terminally ill patients. There were many issues regarding the decision of DNR especially in ethics and cultural aspects. While the medical issues usually arise from the different prognosis by some physicians (Trivedi, 2013) and the junior physician that still lacks encouraging of this type end-of-life palliative treatment teaching (Gibbins et al., 2011 in Wen, 2013)

Nowadays there are controversies around the decision of DNR, stills. In Taiwan that's in the Asian region, there were many patients with cancer in their end-of-life stage used DNR order as their choice. And different to the non-Asian normal practice, due to the ethics and culture, the DNR in Taiwan were majority filled by surrogate (77.2%) instead of the patient him/herself (Wen et al., 2013). Another country in Asian, in Singaporean hospital, according to the study by Phua et al. (2011) also showed that majority of the DNR orders (82.9%) were discussed just with their family instead of the patients themselves.

The huge amount of the DNR order signed by surrogate is a result of the cultural consideration in for Asian people that the physician prefers discussing the patient’s DNR order offering with the family.  The majority of Asian physicians would considerate to not telling their patients completely about their malignant condition until the patient loses consciousness so that the family can easily choose whether taking the DNR order or not (Wen et al., 2013).

Medical provider’s preferences not to discuss the DNR procedure directly towards the patients is not just as result of the lack of teaching or experience in the end-of-life stage treatment, but also the cultural commitment of Chinese ethnic that regards thinking or talking about death as a taboo (Hsu et al., 2009 in Lee et al. 2016). Again, in the case of decision making by the other aspect, medical provider’s, physicians who giving the DNR order by the surrogate’s sign is another result of the cultural consideration.

Every type DNR orders must be fulfilling the standard, whether it’s from the medical side or ethical. The most influencing aspect of DNR subjects in Asian as far was the Eastern Culture consideration so they often used DNR signed by surrogates as their choice.

However, further consideration regarding other aspects is also required to be fitted before any DNR order is finally decided. Fields (2007) in Kasule (2012) stated DNR does not mean ‘Do Not Care’ but the patients should still receive other treatment needed. So that even surrogate is the one who signed the DNR order, the patient won’t get any loss and could live or die normally.

In conclusion, the DNR order required profound determination and consideration regarding various aspects not only medics but most likely ethics in the direct application, especially in the certain culture region. In this short essay has been found the preference of taking the DNR signed by surrogates in Asian region due to the culture ethics instead of signed by the patients, and it’s firmly acceptable as the result of ethical and cultural consideration in the taking of DNR order decision.

KEYWORDS

• Do not resuscitate
• DNR
• DNAR

• Resuscitation
• Cardiopulmonary resuscitation
• CPR

• Medical Ethic
• Ethical
• Ethics

• Eastern
• Asian

• Chinese
• Taiwan

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PS: found this in my old files, references all in docx

*pict wasnt mine, cr to frame

tagged: dibuang sayang 

download full docx: https://goo.gl/m7knTo