"The die is cast": telling patients they are going to die

The decision not to resuscitate a patient with burns is an issue of concern, with advocates both for and against. Most patients have not had previous experience with major burn injuries. It is therefore unreasonable to expect them or their families to act from a position of knowledge. There is a subset of patients considered for "do not resuscitate" orders who are nonsurvivors. If the outcome is predictable, the responsibility of the burn team is to inform patients and their families. Such discussion should come within the first few hours of admission, when the patient is fully awake and able to understand, to respond, and to make plans.