Physicians' perspectives on "do-not-resuscitate" (DNR) orders

Abstract

Background. The purpose of this study was to investigate physicians' perspectives on do-not-resuscitate (DNR) orders at Tokai University hospital, where a euthanasia-like accident occurred several years ago. Methods. A "questionnaire on DNR orders" survey was administered to physicians and the anonymous answers were collected 2 weeks later. Results. Answers were received from 150 of the 400 physicians (37.5%) (surveyed from every department), and revealed that more than 90% of the physicians felt that DNRs were occasionally necessary and that more than 60% of the physicians stated that they had performed DNR. Only 14% of the physicians answered that the patient's consent would be indispensable, and 78% stated that the patient's family and the physician could decide on DNR without the patient's consent being given. Only half of the physicians stated that they regarded it as necessary that DNR order sheets be established hospital policy, and more than 20% of the physicians stated that such an order sheet would not be necessary.Conclusion. There is, in fact, a tacit understanding regarding DNR between physicians and patients/families in medical practice in Japan. However, DNR orders constitute definite medical decisions and procedures. Therefore, such orders should be clearly stated in a standardized format, although such procedures do not seem to be acceptable in the context of the Japanese traditional value system.

The Iranian physicians attitude toward the do not resuscitate order

“…The results also show that there is no significant relationship between physicians’ attitudes toward the DNR order, sex, work experience, and specialty, but there were significant differences between the attitudes of doctors in terms of their education level. In the study of Hosaka et al, 19 >90% of the physicians had a positive attitude toward DNR order. In another study, medical students had significantly more positive attitudes toward DNR order compared to nonmedical students.…”

“…In this study, 67.8% of the physicians had experience in executing the DNR order. In this context, in the study by Hosaka et al, 19 >60% of doctors participated in the decision-making process about DNR order, and this rate was 100% in the study by Cardoso et al 23 Anther study in Iran on resident and intern physicians showed that only 30% of interns and 40% of residents participated in the issuance and implementation of a DNR order. 2 The difference in the participation in DNR may be attributed to the variety in the target groups.…”

“…In fact, studies in the field of DNR order in various countries represents challenges in this regard but have indicated a positive outlook on this relationship. 17 , 19 , 21 – 23 The results of the review of each item found that the doctors declared that DNR order is in line with patient dignity and they believed that it is morally correct. Indeed, it can be said that for many patients, dignity and respect are the last and most important things that they may demand of their relatives and caregivers, particularly if their illness is life-threatening and dangerous.…”

“…This instrument was created by the researcher based on the literature review. 1 , 10 , 19 – 22 The content validity was carried out by consulting with ten faculty members affiliated to the Shahid Beheshti University of Medical Sciences and KUMS, who were experts in nursing, medicine, critical care, and clinical ethics. The reliability was met by calculating the Cronbach’s alpha coefficient, which was equal to 0.88.…”

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

“…103 Japanese nurses participated in the DNR decision almost half of the time, and one third did not believe such orders should be written without the consent of the patient. 104 Recent studies have also been exploring the differences in attitudes toward DNR decision making between physicians, nurses, and other health care professionals, such as bioethicists. Differences in training and personal religious beliefs have been suggested as responsible for variations in attitudes.…”