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In the past, the moral command was to choose life. The contemporary moral dilemma is to choose life under what circumstances. "Now, the emerging trend is to cede moral authority - and with it, responsibility - to patients and families (what ought to be done), while scientific authority (what can be done) remains with the professional" (Curtin, 2010, p. 1). This shift is far too simplistic; instead the public and professionals must determine the separation of what ought to be done from what can be done.
Do-not-resuscitate (DNR) orders were initiated as a method to give competent patients the chance to determine under what circumstances they still choose life. Unfortunately, the discussion usually occurs between the surrogate decision maker and the physician, because the discussion has waited too long and the patient now lacks the mental capacity to decide. The focus of this article is the ethical obligation nurses have to support families and patients in making a DNR decision. Initially, a brief review of the statistics on cardiopulmonary resuscitation (CPR), ethical issues surrounding partial do-not-resuscitate (DNR) orders, and the present timing of DNR discussions will be presented. It will be followed by a discussion of the results of Sulmasy, He, McAuley, and Ury's (2008) study on the difference between nurses' and physicians' beliefs and attitudes on DNR. Though this study points to the acceptance of the majority of attendings for nurses to initiate DNR discussions, in reality nurses often are not included in the preparation or implementation of these discussions. Interwoven throughout this article will be ideas about what nurses can do to facilitate more open DNR discussions.
Moral courage will be needed to overcome fear and stand up for the core values surrounding compassionate end-of-life decision making. Nurses need to put ethical principles, such as veracity, fidelity, and autonomy, into action for end of life (American Association of Colleges of Nurses, 2004). Moral courage enables nurses to face up steadfastly and selfconfidently to ethical dilemmas surrounding the late timing of DNR discussions and the poor communication by physicians of the bad news about prognosis.
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