Is It Ethical to Do Dialysis But Not Cardiopulmonary Resuscitation?

JONA'S healthcare law, ethics and regulation Pub Date : 2011-04-01 DOI:10.1097/NHL.0B013E31821CD8EE

M. S. DeWolf Bosek, Linda MacDonald Glenn, Lorene Reynolds

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Abstract

Summary Apatient’sdesiretohaveaDNRorderwhileconcurrentlyreceiving hemodialysis is not ethically inconsistent, butrather reflects a clear understanding and integration ofthe patient’s values and beliefs and the specific goalsfor dialysis treatment. Nurses have an ethical obligationto assist patients to explore their values and beliefs andto execute an advance directive if desired. Transparentagencypoliciesandopen honest communicationbetweenthe dialysis staff and patients and their significant othersshould promote a mutual trusting relationship.REFERENCES 1. Alport Syndrome Foundation. What is Alport syndrome?2010. http://www.alportsyndrome.org/what-is-alport-syndrome/. Accessed February 22, 2011.2. Norris K. Why do I feel nauseous and lethargic after dialysis?2002. http://www.aakp.org/aakp -library/feel-nauseaus-and-lethargic/. Accessed March 25, 2011.3. Ross LF. Do not resuscitate orders and iatrogenic arrestduring dialysis: should ‘‘no’’ mean ‘‘no’’? Semin Dial. 2003;16(5):395–398.4. Moss AH, Holley JL, Davison SN, et al. Core curriculumin nephrology: palliative care. Am J Kidney Dis. 2004;43(1):172–173.5. Ebell MH, Becker LA, Barry HC, Hagen M. Survival after in-hospital cardiopulmonary resuscitation: a meta-analysis.J Gen Intern Med. 1998;13(12):805–816.6. Moss AH, Holley JL, Upton MB. Outcomes of cardiopul-monary resuscitation in dialysis patients. J Am Soc Nephrol.1992;3(6):1238–1243.7. National Kidney Foundation. When stopping dialysis is yourchoice: a guide for patients and their families. 1989-2006.http://www.kidney.org/atoz/pdf/StopDialysis.pdf. AccessedMarch 22, 2011.8. RobertWoodJohnsonFoundation.Promotingexcellenceinend-of-life care: quality of life. http://www.promotingexcellence.org/tools/quality_life.html. Accessed March 22, 2011.9. Kidney End of Life Coalition. Personal death awareness ex-ercises. http://www.kidneyeol.org/PersonalDeathAwarenessExercises.pdf. Accessed March 22, 2011.10. Omnibus Budget Reconciliation Act of 1990. H.R. 5835.ENR.11. American Medical Directors Association (AMDA). White pa-per on surrogate decision-mak ing and advance care planningin long-term care. http://www.amda.com/governance/whitepapers/surrogate/decision making_hierarchy.cfm. AccessedMarch 24, 2011.12. National Kidney Foundation. Dialysis patients’ bill of rightsand responsibilities. 2003, 2006. http://www.kidney.org/atoz/pdf/DialysisBillRights.pdf. Accessed February 9, 2011.JONA’S Healthcare Law, Ethics, and Regulation / Volume 13, Number 2 / April–June 2011

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做透析而不做心肺复苏合乎伦理吗?

患者在接受血液透析的同时希望有adnorder，这在伦理上并不矛盾，而是反映了对患者价值观和信仰的清晰理解和整合，以及透析治疗的具体目标。护士有道德义务帮助病人探索他们的价值观和信仰，并在需要时执行预先指示。透明的政策和透析人员与患者及其重要他人之间公开诚实的沟通应该促进相互信任的关系。引用1。阿尔波特综合症基金会。什么是阿尔波特综合症?http://www.alportsyndrome.org/what-is-alport-syndrome/。2011年2月22日发布。诺里斯·K.为什么我在透析后会感到恶心和昏昏欲睡?2002。http://www.aakp.org/aakp图书馆/ feel-nauseaus-and-lethargic /。2011年3月25日发布。罗斯低频。透析期间不接受复苏指令和医源性骤停:“不”应该就是“不”吗?Semin Dial. 2003;16(5): 395-398.4。Moss AH, Holley JL, Davison SN等。肾脏病学核心课程:姑息治疗。中华肾脏病杂志，2004;43(1):172-173.5。Ebell MH, Becker LA, Barry HC, Hagen M.住院心肺复苏后的生存:荟萃分析。中华临床医学杂志，1998;13(12):805-816.6。王晓明，王晓明，王晓明。心肺复苏对心脏透析患者预后的影响。中国生物医学工程学报，2004;30(6):1238 - 1237。国家肾脏基金会。何时停止透析是你的选择:患者及其家属指南。1989 - 2006. - http: / / www.kidney.org/atoz/pdf/StopDialysis.pdf。2011年3月22日RobertWoodJohnsonFoundation。促进卓越的临终关怀:生活质量。http://www.promotingexcellence.org/tools/quality_life.html。发布于2011年3月22日。肾脏生命终结联盟。个人死亡意识练习。http://www.kidneyeol.org/PersonalDeathAwarenessExercises.pdf。2011.03月22日发布。《1990年综合预算和解法案》5835.号决议enr.11。美国医学主任协会(AMDA)。长期照护中的替代决策与预先照护计划白皮书。http://www.amda.com/governance/whitepapers/surrogate/decision making_hierarchy.cfm。2011.3.24发布。国家肾脏基金会。透析患者权利与责任法案。2003年,2006年。http://www.kidney.org/atoz/pdf/DialysisBillRights.pdf。2011年2月9日发布。乔纳的医疗保健法律、道德和法规/第13卷，第2号/ 2011年4月至6月

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