1 Nurses can be held morally and legally blameworthy if they fail to provide care that avoids or minimizes the risk of harm to patients. .
Professional malpractice is negligence in which the standards of care have not been met.5 The nurses in Memorial Hospital vs. Darling were found negligent when Dorrence Darling's broken leg became gangrenous and had to be amputated. By not reporting the condition of the cast and the physician's negligence, the nurses had not prevented the patient's harm, nor acted according to the principle of nonmaleficence. .
The debate about forgoing life-sustaining treatment also falls within the category of nonmaleficence. Caregivers may view the act of withdrawing life-sustaining treatment as making them responsible for the patient's death and therefore different from the act of never starting the life-sustaining treatment. Caregivers, patients, and families may worry about the distinction between withholding and withdrawing treatment because they think a therapy once begun cannot be stopped. But in some cases it is only after a treatment has been started that a proper diagnosis and prognosis can be made.1 .
Treatment that can be withheld can also be withdrawn. Patients or their surrogates have the right to forgo treatment at any time under the principle of respect for autonomy. Their decisions should be based on considerations of the burdens and benefits of treatment from the patient's or surrogate's standpoint. This is true for do-not-resuscitate orders, as well as other treatments.1 .
A DNR order, or "no code" order, means that cardiopulmonary resuscitation is not to be attempted. Only when a DNR order is written may CPR be omitted. Decisions for writing a DNR order are based on the patient's preference, determinations of medical futility, and the patient's quality of life.8 The presence of a DNR order does not imply the withdrawal of other types of care. Each treatment should be evaluated individually for appropriateness according to the burdens vs.