The Use and Implications of Do Not Resuscitate Orders in Intensive Care Units
Zimmerman, Jack E.
Knaus, William A.
Sharpe, Steven M.
Anderson, Andrew S.
Draper, Elizabeth A.
Wagner, Douglas P.
JAMA. 1986 Jan 17; 255(3): 351-356.
Researchers at the George Washington University Medical Center (GWUMC) studied "do not resuscitate" (DNR) practices in the intensive care units of 13 hospitals covering 7,265 admissions. Variations found in the use and timing of DNR orders were attributed to physician treatment decisions rather than to patient presentation. DNR decisions were frequently accompanied by withdrawal of other life-support therapy. Information collected at GWUMC supported the contention that the physician is dominant in the DNR decision, that families do participate in the discussion, but that patient participation is low--frequently due to reduced consciousness. The authors conclude that physician recognition of the limits of aggressive medical care is compatible with the ethical values of not prolonging death unnecessarily, avoiding treatment that does not positively affect the patient's condition, and distributing medical resources to patients who are most likely to benefit. (KIE abstract)
Aged; Allowing to Die; Consciousness; Death; Decision Making; Diagnosis; DNR Orders; Do Not Resuscitate Orders; Family Members; Hospitals; Institutional Policies; Intensive Care Units; Life; Mortality; Patient Participation; Patients; Physicians; Prevalence; Prognosis; Researchers; Resource Allocation; Resuscitation; Resuscitation Orders; Selection for Treatment; Statistics; Survey; Values; Withholding Treatment;
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Jayes, Robert L.; Zimmerman, Jack E.; Wagner, Douglas P.; Draper, Elizabeth A.; Knaus, William A. (1993-11-10)