DNR v Assisted Suicide

[McCulloch]

A "Do not resuscitate" (DNR) order is an instruction from a person to medical persons to be passive regarding treatment of a life-threatening condition. Withholding such treatment without the DNR would be against the law. Assisted suicide would be performing an act, on the instructions from the person affected, to end that person's life.

1. Are these two things ethically different? Why or why not? Should the laws be changed, where one is illegal and the other is not?
2. Does the Bible or any other religious text provide any help whatsoever in addressing this issue?

[Frosty]

Bare with me, this is my first post, but- A. I would say more secular ethical philosophies would contend they are at most very similar, if not ethically equivalent. They both deal with a persons ownership of its own existence, one being a conscious decision and request of action (Assisted Suicide), one simply being a decision on pending action.(DNR)

That being said most non-secular religious ethics set a heavy price on human life as well as taking it, in any fashion. But I'm not sure the amount of discernment between the two Theists would adorn.

Personally I would contend the laws remain the same, but the subject be closely studied and debated so action can be taken in the near future. Perhaps in a less polar political climate focusing on social issues prominently. However I would contend both be legal, and a person has ownership over his or her own existence.

B. I must admit I'm not quite a biblical expert, but I'm finding that Resuscitation techniques didn't come about until the early twentieth century, so without liberal applications of the text the Bible has little to say on something like DNR. Assisted Suicide, I'm very sure most mainstream religious ideology would condemn.

[McCulloch]

I do not see that there is an ethical difference. In the case of DNR, a person is instructed to withhold treatment. But without those instructions, withholding that treatment would be illegal and immoral. How can that be any different from assisting the dying person end it all?

I have seen nothing in the official teachings of any of the major religions which is of any help to determine these types of ethical issues. My conclusion: the major religions are anachronistic and somewhat useless when it comes to modern ethical issues.

[Slopeshoulder]

The subtle but perhaps crucial distinction is that DNS is passive and AS is active on the part of physicians; DNS is letting nature take its course, and AS is helping one to die.

Having said that, I'm for the legalisation and destigmatization of suicide, assisted or otherwise. I think that human irrationalism re: the alleged value of life in all circumstances, combined with the hypocratic oath run amok, silly religious notions, and the medical-industrial complex all intersect to keep suicide off the table, which I think is a shameful, irrational, and inhumane state of affairs. I have NO plans, but I'd want it on the table as an option should my health and-or quality of life tank for precipitously and for good.

Regarding what religion might have to say, I reject biblio-reductionism and instead refer to the entirety of religion. The catholics seem to have a rational and balanced approach that came up in another thread, which I'd simplify and sum up as: try not to give up on life, hope, and grace, and check yourself for mental illness, but if you feel you must and are in your right mind, remember god is graceful, welcoming, loving and merciful, so no worries.

[Confused]

A "Do not resuscitate" (DNR) order is an instruction from a person to medical persons to be passive regarding treatment of a life-threatening condition. Withholding such treatment without the DNR would be against the law. Assisted suicide would be performing an act, on the instructions from the person affected, to end that person's life.

1. Are these two things ethically different? Why or why not? Should the laws be changed, where one is illegal and the other is not?
2. Does the Bible or any other religious text provide any help whatsoever in addressing this issue?

This is something that comes up quite frequently in my profession and the actual meaning of DNR is really quite loose. For some, it means no defibrillation but compressions and ACLS drugs as well as intubation is acceptable. For some it means no compressions but defibrillating and intubation is acceptable. For some it means everything except intubation is acceptable. It varies so much that it really has no consistency. Our current forms have four options:
1) Full Code: ACLS guidelines and intubation
2) Chemical Code: No compressions, no shocks, no intubation, but drugs such as atropine, epinephrine, sodium bicarb, etc... are acceptable.
3) Partial code: Intubation, compressions, and ACLS drugs are fine but no defibrillation or external pacing.
4) DNR/DNI: No ACLS, no intubation, no vasopressors.

Where the ethical part becomes a concern is when someone isn't diagnosed with a terminal illness and still requests a DNR/DNI. At that point, we need to look at their competency to make such a decision and then we honor that request until the patient is unconscious at which point the family can override the patients requests. However, if one is diagnosed with a progressively terminal illness, we don't actually help them die. We simply make them comfortable while nature takes its course. Usually, this means we place them on a morphine or Fentanyl drip and give them anxiolytics as needed to keep them comfortable but we don't give antibiotics, artificial nutrition (except the occasional IV normal saline or Ringers Lactate for hydration), vasopressors, or any other life sustaining medications. It is considered comfort care only. If there is a hospice facility in the area, they are sent there. If not, they are either tended to at home by a hospice nurse and family or they are admitted to a medical floor to be cared for until nature takes its course.

In some cases, all efforts are made to restore the patients bodies equilibrium with some hope of a partial recovery. If indicators start to show that the patient won't make any meaningful recovery, the family sits down with us and we discuss what the patient would have wanted. If the patients only hope of recovery is comatose, most families will opt to have life support discontinued and we respect that choice. But some will still hold out hope in which case the patient is usually sent to a long term ventilator capable facility to live out their remaining life on a breathing machine, feeding through a gastrostomy tube, and having their diapers changed. To me, robbing them of that last bit of dignity is the ultimate in cruelty. But they aren't my family and I must honor their choice.

I don't know of any scriptural guidelines that one could follow in such circumstances. When scripture was written, such dilemmas didn't really exist as the technology wasn't even considered as it may have been construed as heresy or interfering with Gods plan.