Do not attempt resuscitation order in Japan.

Area of Science:

• Medical Ethics
• Healthcare Policy
• Emergency Medicine

Background:

• Do Not Attempt Resuscitation (DNAR) orders are widely practiced in Japan.
• There is a lack of established laws and formal guidelines governing DNAR in the country.

Purpose of the Study:

• To investigate the current implementation of DNAR orders in Japanese medical institutions.
• To identify challenges and issues associated with DNAR practices.
• To propose improvements for DNAR order application.

Main Methods:

• A questionnaire survey was conducted among medical institutions in Kanagawa Prefecture.
• The survey focused on the current status and practices related to DNAR orders.

Main Results:

• DNAR orders are utilized in approximately 90% of surveyed hospitals.
• Only about 30% of hospitals have established in-hospital DNAR guidelines.
• Patient involvement in DNAR decision-making is lacking in approximately 80% of hospitals.
• The absence of legislation creates ambiguity in resuscitation decisions for out-of-hospital cardiac arrests.

Conclusions:

• Prefectures, municipalities, and local medical authorities should lead the establishment of DNAR ordinances.
• Developing comprehensive DNAR guidelines is crucial for consistent and ethical practice.
• Addressing the legal and procedural gaps in DNAR is necessary to improve patient care and reduce ambiguity.