Navigating DNR Dilemmas: The Ethics of Patient Autonomy

Prompt

THE WRONGFUL RESUSCITATION The DNR Conflict: When Family Insists Against an Advance Directive Introduction Do-Not-Resuscitate (DNR) orders reduce suffering and protect patient autonomy. Conflict emerges when family members demand resuscitation despite a patient’s clear, documented wishes. This poster outlines a real-world case and applies Kohlberg’s and Gilligan’s moral development theories to understand the ethical tensions. Case Summary: The Wrongful Resuscitation An 80-year-old man with multiple chronic illnesses had clearly chosen comfort care and signed a DNR. After surgery, the surgeon—feeling responsible for the patient’s recovery—changed the DNR to “full code.” An ethics consult reversed the decision, restoring the patient’s stated wishes. He later died naturally without resuscitation. This case highlights the moral clash between patient autonomy, family emotions, and professional responsibility. Key Ethical Principles Autonomy Respecting a competent patient’s right to refuse treatment. Beneficence & Non‑maleficence Providing benefit and preventing avoidable harm. Unwanted resuscitation causes suffering. Justice Using medical resources fairly and responsibly. Professional Integrity Clinicians must uphold ethical codes that prioritize patient wishes. Core Values at Stake Respect for patient autonomy Compassion and comfort‑focused care Truthfulness and clear communication Support for family distress Medical professionalism Priority Order: Patient’s documented wishes Minimizing suffering Supporting family needs Fair resource use Arguments in the Conflict Why Honor the DNR? Upholds autonomy and law Avoids harm and unnecessary suffering Maintains trust in healthcare ethics Why Override the DNR? (Family/Physician Perspective) Hope, denial, or fear of guilt Desire to "do everything" Clinician emotional investment or personal values Kohlberg’s Moral Development: Applied Level 1: Preconventional Stage 1: Staff fear punishment or conflict. Stage 2: Family seeks to relieve personal guilt. Level 2: Conventional Stage 3: Providers want to please family. Stage 4: Others insist on following policies/laws strictly. Level 3: Postconventional Stage 5: Ethics team defends patient rights and social trust. Stage 6: Highest moral reasoning prioritizes universal principles of autonomy and non‑harm. Mapping: Families often reason at stages 2–3; ethics teams at 5–6. Gilligan’s Ethics of Care: Applied Level 1: Self‑Interest Family fear and emotional distress drive decisions. Level 2: Goodness / Self‑Sacrifice Family believes "a good loved one keeps fighting," even when harmful. Level 3: Non‑Violence & Balanced Care Clinicians help families see that honoring the DNR is the most caring, least harmful option. Gilligan emphasizes relationships, emotions, and care—not just rules. Ethical Best Action Honor the DNR while providing: Compassionate family support Honest communication Interdisciplinary collaboration Ethics consultation for conflict resolution

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