Support of patient autonomy in the do not resuscitate decision

In this study we examined critical care nurses' beliefs concerning the support of patient autonomy in the do not resuscitate (DNR) decision. The study sample consisted of 251 members of the American Association of Critical-Care Nurses (AACN). Subjects were asked to examine four hypothetical cases and select the agent (patient, family member, physician, or nurse) (1) most appropriate to support patient autonomy in the DNR decision and (2) who would actually make the DNR decision, if these hypothetical cases were to occur on the clinical units where the subjects were employed. The nurses' answers concerning the agent best able to support patient autonomy in the DNR decision were in general agreement with the do not resuscitate decision model developed by the principal investigator (B.B.O.) to demonstrate support for patient autonomy in the DNR decision. However, when asked who would actually make the DNR decision on their units, the nurses frequently responded that the physician would make the decision, regardless of the agent selected as best able to support patient autonomy in the case situation. An ethical conflict concerning the DNR decision appeared to exist for the majority of the subjects in this study.