The do-not-resuscitate order in a nursing home: patient's choice or staff's decision

An 86-year-old woman in a residential health care facility suffered a massive stroke; immediate intubation was performed, she was transferred to a nearby hospital where she died two months later. Within 48 hours of this event, three mentally competent residents and one family member on the unit requested a do-not-resuscitate order. They, along with the seven other mentally competent and non-terminal residents on the unit, participated in a questionnaire survey, the purpose of which was to elicit information on DNR attitudes. Only one respondent requested cardiopulmonary resuscitation. All insisted that do-not-resuscitate decisions were theirs alone to make. A staff questionnaire was given to 81 employees having many years of health care experience. Most had witnessed death and cardiopulmonary resuscitation and knew of its poor outcome. However, 51% were very willing to participate in cardiopulmonary resuscitation, and 65% thought cardiopulmonary resuscitation was worthwhile in residential health care facilities. Furthermore, 56.8% thought that families should participate in the decision. The dichotomy between residents' wishes and staff perceptions merits recognition and further study.