Do Not Resuscitate Dilemmas

by Michael Webb-Peploe

Read: Do Not Resuscitate Dilemmas (Part 1)

Legal Situation
Currently in UK’s legal situation is not totally clear. However most commentators agree that doctors can make DNR orders without consulting their patients in two key situations. The first is if the person’s health is so poor that they are unlikely to survive CPR. The argument here is that recommending resuscitation for a patient with severe pneumonia is as inappropriate as recommending chemotherapy, a liver transplant or any other form of invasive therapy. The resuscitation is not going to achieve anything so it should not even be a matter of debate.

The second situation is where the doctor believes that a patient is mentally incompetent. In this situation, however there is normally the possibility of discussing the situation with relatives or friends.

In the USA the legal situation is laid down in a set of so-called ‘right-to-die cases’. These establish that a person has a right to refuse life-sustaining treatment whether he or she is thought of as competent or incompetent. US law sees no difference between not starting (withholding) and stopping (withdrawing) a treatment.

The courts do distinguish between withdrawing treatment and active euthanasia or physician assisted suicide, neither of which are fundamental liberties protected by the American Constitution.9

Matters of Life
A Christian assessment of the issues surrounding resuscitation needs to start from the realisation that however poor, ill, disabled or even in pain a person is, his or her life is never futile. Human beings are God-like beings. The Bible sates that human beings are made in God’s image – a statement that says more about values than physical attributes.

Being made in God’s image means that we should respond to each other with wonder, respect, empathy and above all with an attitude that seeks to protect each other from abuse, harm, manipulation and from wilful neglect.

A person who is exceedingly ill is still a person. Even if a decision is made that attempts at resuscitation are so unlikely to succeed that it would be inappropriate to try, this does nothing to diminish the value placed on the person. Indeed recognising that a person is weak and incapable of self-defence is useful as it highlights our duty of care. In this case we have a responsibility to increase, rather than decrease, our effort to care for the person.

A consequence of this high view of life is that we must distinguish removing suffering from removing the sufferer. Any action that sets out with the intention of destroying a human life desecrates God’s image. There can, however, be times when it is entirely appropriate to decide not to give some form of treatment, because that treatment has little or no chance of helping the person, and giving it could be distressing.

In addition to looking at a person’s life in isolation, we need to consider their position within society. Not only is each individual human life special, we are all part of the human family. We are created to live in community. To think that matters of life and death can be decided in isolation by a single individual is a dangerous illusion.

A person deciding to take their own life, for example, will affect the lives of family and friends. A society that sees this as an option is likely to become one that makes less provision for people in need. As such the society itself becomes poorer.

Great care needs to be taken so that consideration may be appropriate are not biased by vested interests of relatives or carers. Just because these people may be becoming physically or financially exhausted, this is no reason for taking decisions that will hasten the death of another person. The morally strong solution is to find additional support for all the people involved in the situation.

Questions of Death
Contemporary society is uneasy about death. It is a taboo subject that is seldom discussed. Contemporary medicine can equally be accused of being scared to talk about death and there is a tendency to see death as the ultimate failure. This is strange, as death is the one certainty for all living things.

Christianity is torn between seeing disease and death as outrages against God’s creation, and as means of moving towards closer relationships with God. Many Christians join the writer C.S. Lewis in seeing pain as God’s ‘megaphone to rouse a deaf world.’10 Pain, illness and death are seen as inevitable consequences of humankind’s decision to ignore their creator God.

While old age may have its frustrations as health starts to fail, it is not an evil, but rather a stage of life to be respected and honoured.

Death, however, does provide merciful release from life trapped in a damaged and decaying body. Christians believe that life continues after the body ceases to function, with the possibility of spending eternity in peace and in an unimaginably close relationship with the God who created everything.

Read more: Do Not Resuscitate Dilemmas (Part 3-end)

Christian Medical Fellowship (CMF) Files No. 53, 2014