Do-not-resuscitate orders - Should the patient be informed?

Abstract

Objectives. To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR). Design. Questionnaire. Setting. Nationwide, 6 months after the publication of guidelines on DNR in 1994. Subjects. A 10% random sample of the members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Main outcome measures. To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? Results. Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient, but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. Conclusions. Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?.