Does the DNR patient belong in the ICU?

Area of Science:

• Critical Care Medicine
• Bioethics
• Nursing Ethics

Background:

• A notable percentage of Intensive Care Unit (ICU) patients receive Do-Not-Resuscitate (DNR) orders during their stay.
• DNR patients in the ICU tend to be sicker, consume more resources, and have higher mortality rates than non-DNR patients.
• Current healthcare challenges like nursing shortages and rising costs prompt questions about ICU resource allocation for DNR patients.

Purpose of the Study:

• To evaluate the appropriateness of excluding Do-Not-Resuscitate (DNR) patients from Intensive Care Units (ICUs).
• To analyze the ethical and practical implications of a potential policy to exclude DNR patients from the ICU.

Main Methods:

• The study examined a model policy for excluding DNR patients from the ICU.
• Ethical principles including patient autonomy, beneficence, nurse-patient relationship, and fidelity were considered.
• The concept of 'point Z' on the life-death continuum was used to define appropriate and inappropriate treatment goals.

Main Results:

• A policy to exclude DNR patients from the ICU was rejected.
• Exclusion could negatively impact patient autonomy, beneficence, the nurse-patient relationship, fidelity, and the practice of DNR orders.
• Excluding DNR patients would not effectively resolve ICU triage issues.

Conclusions:

• DNR patients may require ICU care for curative or palliative treatments if goals are reasonable and ICU is the only option.
• DNR patients are not suited for the ICU if treatment goals are inappropriate or care can be provided elsewhere.
• Beyond 'point Z', only palliative treatment is ethically justified in the ICU for DNR patients; curative treatments are inappropriate.