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Deciding not to resuscitate in Dutch hospitals.

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  • 1. Department of Public Health and Social Medicine, Erasmus University, Rotterdam, The Netherlands.
      Authors
    • van Delden JJ 1
    (1 author)

Journal of Medical Ethics, 01 Dec 1993, 19(4):200-205
https://doi.org/10.1136/jme.19.4.200 PMID: 8308873 PMCID: PMC1376338

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Abstract 

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 per cent 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.

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J Med Ethics. 1993 Dec; 19(4): 200–205.
PMCID: PMC1376338
PMID: 8308873

Deciding not to resuscitate in Dutch hospitals.

J J van Delden, P J van der Maas, L Pijnenborg, and C W Looman
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Abstract

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 per cent 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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
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