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Do-not-resuscitate order after 25 years.
Jeffrey P Burns1, Jeffrey Edwards, Judith Johnson
1Department of Anesthesia, Harvard Medical School, Boston, MA, USA.
Critical Care Medicine
|May 29, 2003
Summary
Do-Not-Resuscitate (DNR) orders evolved to allow open decision-making for resuscitation, but concerns persist. Presuming consent for resuscitation is reasonable only when patient wishes are unknown and actively sought.
Area of Science:
- Medical Ethics
- Critical Care Medicine
- Palliative Care
Background:
- The concept of Do-Not-Resuscitate (DNR) orders emerged in 1976, sparking ongoing debate and evolution in medical practice.
- DNR orders represent a significant, yet controversial, aspect of modern medicine, symbolizing patient autonomy and end-of-life care discussions.
Purpose of the Study:
- To comprehensively review the historical development of DNR orders.
- To analyze the implementation strategies and current status of DNR policies.
- To examine the ongoing ethical considerations and controversies surrounding DNR orders.
Main Methods:
- This study employed a review article methodology.
- Analysis of existing literature and historical documents pertaining to DNR orders.
Main Results:
- DNR orders introduced a framework for open decision-making regarding resuscitation.
- These orders have been instrumental in limiting the routine application of cardiopulmonary resuscitation in dying patients.
- Persistent concerns and challenges remain regarding the consistent and ethical application of DNR policies.
Conclusions:
- While presuming consent for resuscitation is acceptable for patients with unknown wishes during cardiopulmonary arrest, this presumption requires active and prompt clarification of patient or surrogate preferences.
- The DNR order serves as a crucial catalyst for initiating informed patient directives and end-of-life discussions.
- Continuous efforts are needed to ensure DNR orders facilitate shared decision-making and respect patient autonomy.
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