Deciding Not to Resuscitate in Dutch Hospitals
van Delden, Johannes J.M.
van der Maas, Paul J.
Looman, Caspar W.N.
Journal of Medical Ethics. 1993 Dec; 19(4): 200-205.
The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 percent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable.
Attitudes; Competence; Consent; Consultation; Decision Making; Evaluation; Evaluation Studies; Futility; Hospitals; Informed Consent; Institutional Policies; International Aspects; Life; Medical Specialties; Motivation; Nurses; Paternalism; Patient Participation; Patients; Physicians; Quality of Life; Resuscitation; Resuscitation Orders; Risks and Benefits; Statistics; Survey; Values;