Beslissen om niet te reanimeren : een medisch en ethisch vraagstuk

Abstract

The fight against an untimely death is an element of medical science which comes to the fore especially with cardiopulmonary resuscitation. A successful resuscitation constitutes a victory over death. Hence modem resuscitation techniques are considered one of the breakthroughs which advanced medical science has offered humanity. The importance of resuscitation is reinforeed by the fact that everyone eventually dies. For everyone there is the moment when heartbeat and/or respiration fails. Thus all humanity is a possible candidate for resuscitation. However, resuscitation has its drawbacks. Resuscitation is more often than not unsuccessful and practising it involves some technical violence. When the resuscitation attempt is not successful, than the process of dying can be severely disturbed while nothing positive can be attributed to the intervention. Moreover, not for all people death needs to be fought with all possible force. In short, somelimes it is better not to resuscitate at all. The question which then needs to be faced is 'when not to resuscitate?'. This question is the subject of the present dissertation. An added problem is the fact that the decision to resuscitate needs to be taken quickly. Hence the question 'should this patient be resuscitated or not?' must be answered when there is time to think it over. When this kind of decision-making process leads to the decision not to intervene, a DO NOT RESUSCITATE-decision has been taken. The central issue of this thesis is: Which grounds allow a DNR-decision to be taken. This matter derives its moral importance from the fact that by taking a DNR-decision one takes the responsibility that the decision may shorten a patient's life. The objective of this study is not limited to a norrnalive analysis of the reasons not to resuscitate. The aim is to offer some considerations with which to fonnulate a DNR-policy as well. In another aspect the study is limited: the answers to the questions poscd are aimed at taking DNR-decisions in hospitals and for patients who have reached majority.