Should There be a Choice for Cardiopulmonary Resuscitation When Death is Expected? Revisiting an Old Idea Whose Time is Yet to Come

Ditillo, Betty A.

doi:10.1089/10966210252785079

Cited by 21 publications

(24 citation statements)

References 67 publications

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“…This may reflect the view that the DNR order is a medical decision regarding a treatment with medical indications that do not have to be discussed with the patient or family if the treatment is thought to be inappropriate for the patient. [534–36] In keeping with local guidelines, the Scottish integrated policy on decision making and communication of DNR orders states that where CPR is unlikely to have a medically successful outcome, it should not be attempted and it is “an unnecessary and cruel burden” to ask patients and relevant others to decide about CPR when it is not a treatment option. [353738]…”

Section: Discussionmentioning

confidence: 99%

Should patients and family be involved in "Do not resuscitate" decisions? Views of oncology and palliative care doctors and nurses

Yang¹,

Kwee²,

Krishna³

2012

Indian J Palliat Care

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Background:“Do not resuscitate” (DNR) orders are put in place where cardiopulmonary resuscitation is inappropriate. However, it is unclear who should be involved in discussions and decisions around DNR orders.Aim:The aim was to determine the views of oncology and palliative care doctors and nurses on DNR orders.Materials and Methods:A questionnaire survey was conducted on 146 doctors and nurses in oncology and palliative care working within a tertiary specialist cancer center in Singapore.Results:Perceived care differences as a result of DNR determinations led to 50.7% of respondents reporting concerns that a DNR order would mean that the patient received a substandard level of care. On the matter of DNR discussions, majority thought that patients (78.8%) and the next of kin (78.1%) should be involved though with whom the ultimate decision lay differed. There was also a wide range of views on the most appropriate time to have a DNR discussion.Conclusions:From the viewpoint of oncology and palliative care healthcare professionals, patients should be involved at least in discussing if not in the determination of DNR orders, challenging the norm of familial determination in the Asian context. The varied responses highlight the complexity of decision making on issues relating to the end of life. Thus, it is important to take into account the innumerable bio-psychosocial, practical, and ethical factors that are involved within such deliberations.

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Section: Discussionmentioning

confidence: 99%

Should patients and family be involved in "Do not resuscitate" decisions? Views of oncology and palliative care doctors and nurses

Yang¹,

Kwee²,

Krishna³

2012

Indian J Palliat Care

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“…A joint statement from the British Medical Association, the Royal College of Nursing and the UK Resuscitation council recommended that resuscitation status should be discussed with patients before they get critically ill 6. Others have suggested that patients do not need to be involved in the decision although they should be told of the health professionals’ decision 7. We believe that most healthcare professionals feel that patients should be involved, if that is possible, but in practice discussions are often left until patients are too ill to be involved.…”

Section: Discussionmentioning

confidence: 99%

Patients’ attitudes towards “do not attempt resuscitation” status

et al. 2008

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This study suggests that contrary to current practice most patients want to discuss their DNAR status prior to becoming critically ill. This includes half of the small number that find it distressing to discuss. Although most patients are comfortable with relatives being involved in discussing DNAR, a significant proportion do not want their relatives to be asked. Furthermore, once a decision has been made, the majority of patients want it to be more accessible than current practice allows.

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“…Some have argued that the DNR decision is a medical decision and that doctors need neither offer or discuss CPR nor obtain patient consent for recording a DNR order (Ditillo, 2002;Marik & Zaloga, 2001). Nonetheless, as with all decisions referring to individual patients, the dominant principle guiding medical practice regarding DNR orders is that of patient autonomy (Burns et al, 2003).…”

mentioning

confidence: 99%

The Implications of Dying Cancer Patients' Talk on Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders

Eliott

Olver

2007

Qual Health Res

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Current medical emphasis on autonomy requires that patients be primary in authorizing do-not-resuscitate (DNR) orders, countermanding provision of cardiopulmonary resuscitation (CPR) on terminally ill patients. The assumptions that patients make regarding CPR and DNR orders will influence their choices about them. Using discursive analysis, the authors examined the speech of 28 patients dying of cancer regarding the appropriateness of refraining from CPR or of instituting DNR orders. Most participants identified CPR as inappropriate in their circumstances, favoring institution of DNR orders. However, a minority drew on dominant construals of DNR orders and CPR to locate themselves outside the category of suitable candidates for DNR orders, thus justifying a preference for CPR--even though some had current DNR orders. Doctors' and patients' assessments of eligibility for DNR orders might not coincide, and when patient autonomy is presumed by patients to be determinant, discrepancies between patient expectations and instituted medical practice are inevitable.

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Should There be a Choice for Cardiopulmonary Resuscitation When Death is Expected? Revisiting an Old Idea Whose Time is Yet to Come

Cited by 21 publications

References 67 publications

Should patients and family be involved in "Do not resuscitate" decisions? Views of oncology and palliative care doctors and nurses

Should patients and family be involved in "Do not resuscitate" decisions? Views of oncology and palliative care doctors and nurses

Patients’ attitudes towards “do not attempt resuscitation” status

The Implications of Dying Cancer Patients' Talk on Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders

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