Decision to resuscitate or not in patients with chronic diseases

Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary resuscitation (CPR) in case of cardiac arrest.

We carried out a questionnaire survey among 112 haemodialysis patients and 17 physicians at department of nephrology, Herlev Hospital. The patients were interviewed orally, the physicians responded to written questionnaires.

The majority of patients (86%) and physicians (88%) answered, that patients ought to be involved in the DNR decision. However they both wanted to be the final decision maker. Most patients (69%) desired CPR in case of cardiac arrest. Physicians would attempt to resuscitate 88% of the patients. In 30% of the cases, the patient and the physician disagreed on whether or not to attempt resuscitation.

Both patients and physicians think they ought to make the final DNR decision. In practice, patients are often not involved. Since the patient and the physician disagree regarding the indication for CPR in one third of the cases, we must assume that many patients are resuscitated against their wishes. National guidelines are required.

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