Do Not Resuscitate Orders: Key Ethical Issues

As patients, surrogate decision makers, and clinicians discuss goals of care, questions arise regarding what interventions will physiologically work and what interventions will honor the patient’s values. Do Not Resuscitate Orders are one of the interventions frequently discussed. Our lead contributor on this episode (Mark Repenshek, Executive Director for Ethics & Mission at Hospital Sisters Health System, in Wisconsin) is in conversation with guest to explore a number of ethical issues related to Do Not Resuscitate orders that include, but are not limited to: a) Patient/Surrogate desires for full resuscitation despite the intervention’s lack of efficacy in specific clinical circumstances, b) Consideration of partial codes as a “compromise” co-status, c) A physicians’ professional right to limit the use of resuscitation efforts in certain circumstances. The episode also introduces a new series within the EthicsLab Podcast called EthicsLab Essentials. This new series is designed to be an introductory series of modules to enrich ethics committee members.

Practical Tools Helping Ethics Committees

Health care ethics committees help patients and clinicians with tough choice decisions. Within this work of clinical ethics consultation, what are practical tools being used to improve their competence and impact? In this episode, our guests present such practical tools that help health care ethics committee members become more competent, become more aware of gaps and trends, and have more impact on improving the care and health experience of patients.

Our guests in this episode include:

  • Becket Gremmels, PhD, System Director of Ethics, Mission Integration Department. CHRISTUS Health
  • Katherine Wasson, PhD, MPH, Associate Professor, Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago
  • Mark Repenshek, PhD, Executive Director, Ethics & Mission, HSHS Eastern/Western Wisconsin Division, Door County Medical Center
  • Laura J. Bishop, Ph.D, Associate Teaching Professor and Academic Program Manager, Kennedy Institute of Ethics, Georgetown University

Additional Resources in this Episode: 

10 Week Free Online Introduction to Bioethics (presented by Laura Bishop)

Ethics Tracker Screenshots (presented by Becket Gremmels)

REDCap Software  (presented by Becket Gremmels)

The ACES Project: Online Clinical Ethics Consultation Skills Assessment (presented by Katherine Wasson)

HCEUSA Dashboard Article 2012 (presented by Mark Repenshek)

Dashboard 2011 Data (presented by Mark Repenshek)

Thinking Differently: Building Blocks for a Quality Ethics Program

Are there better ways to build and support a culture of clinical ethics in healthcare? What might that look like? What has worked and how could the ideas and tools offered be implemented? In the late 1990’s the idea was proposed, why not marry the work being done in health care ethics with quality improvement methodology. Would this type of “Thinking Differently” help us get traction and improve the systems and initiatives that clinical ethics tries to accomplish? These are some of the questions and issues that our guests will wrestle with as well as offering concrete examples and even practical solutions being tested today.