Do Not Resuscitate (DNR) Decision: Who Makes It? (Disturbing Research, Video 4:16)

Who really decides not to restart the heart during a cardiac arrest situation? Many patients may not realize that the decision is a complex one involving nurses and physicians with a wide variety of their own personal experiences and perspectives about how the situation should be handled. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians concerning patient involvement and information. In addition, decision-making has been reported to be unclear with inconsistent documentation.

A researched web research study on DNR decision making including 132 nurses and 84 physicians reported the following results:

1) Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR.

2) Twenty-one percent found it unimportant to inform patients of the DNR decision.

3) Fifty-seven percent reported that providing information to the patient was important, but only twenty-one percent stated that this was likely to happen.

4) Attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values.

5) Nurses chose patient autonomy as the most important value, while physicians rated non-maleficence (no harm) as the most important value in relation to DNR decisions.

This research is very disturbing and clearly shows the need for more and better interventions to ensure patients' values and preferences are addressed and integrated into end-of-life decisions. The importance of patients having Advance Directives done detailing their healthcare wishes and selecting surrogates who will truly advocate for them can’t be emphasized enough.

Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so they can develop a deeper understanding of the decisions, especially in cases where they disagree. The organization needs to support such discussions through providing an environment that allows ethical discussions on a regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.

In recent years, wearing a tattoo stating “Do Not Resuscitate” has become more popular as a way to safeguard one’s healthcare rights regarding this topic. Should a tattoo of an incapacitated patient be honored? Art Caplan, head of the Division of Medical Ethics at the NYU School of Medicine discusses such a case in this video:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

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