David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 39 (3):158-165 (2013)
Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
J. Wilson (2008). To What Extent Should Older Patients Be Included in Decisions Regarding Their Resuscitation Status? Journal of Medical Ethics 34 (5):353-356.
Barbara Hayes (2010). Trust and Distrust in Cpr Decisions. Journal of Bioethical Inquiry 7 (1):111-122.
Adrienne M. Martin (forthcoming). Tales Publicly Allowed. Hastings Center Report.
Dominic Wilkinson (2009). The Self-Fulfilling Prophecy in Intensive Care. Theoretical Medicine and Bioethics 30 (6):401-410.
Merle Spriggs (2005). Autonomy and Patients' Decisions. Lexington Books.
G. S. Robertson (1993). Resuscitation and Senility: A Study of Patients' Opinions. Journal of Medical Ethics 19 (2):104-107.
Charles Weijer, Cardiopulmonary Resuscitation for Patients in a Persistent Vegetative State: Futile or Acceptable?
R. Sivakumar (2004). Communicating Information on Cardiopulmonary Resuscitation to Hospitalised Patients. Journal of Medical Ethics 30 (3):311-312.
Rebecca Kukla (2005). Conscientious Autonomy: Displacing Decisions in Health Care. Hastings Center Report 35 (2):34-44.
G. E. Mead & C. J. Turnbull (1995). Cardiopulmonary Resuscitation in the Elderly: Patients' and Relatives' Views. Journal of Medical Ethics 21 (1):39-44.
A. J. Gorton, N. V. G. Jayanthi, P. Lepping & M. W. Scriven (2008). Patients' Attitudes Towards "Do Not Attempt Resuscitation" Status. Journal of Medical Ethics 34 (8):624-626.
Rebecca Kukla (2007). How Do Patients Know? Hastings Center Report 37 (5):27-35.
Jakob Hohwy & David Reutens (2009). A Case for Increased Caution in End of Life Decisions for Disorders of Consciousness. Monash Bioethics 28 (2):13.1-13.13.
P.-A. Abboud (2006). What Determines Whether Patients Are Willing to Participate in Resuscitation Studies Requiring Exception From Informed Consent? Journal of Medical Ethics 32 (8):468-472.
P. N. Bruce-Jones (1996). Resuscitation Decisions in the Elderly: A Discussion of Current Thinking. Journal of Medical Ethics 22 (5):286-291.
Added to index2012-11-09
Total downloads3 ( #345,782 of 1,692,619 )
Recent downloads (6 months)1 ( #181,402 of 1,692,619 )
How can I increase my downloads?