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Journal of General Internal Medicine

, Volume 26, Issue 7, pp 791–797 | Cite as

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

  • Jacqueline K. Yuen
  • M. Carrington ReidEmail author
  • Michael D. Fetters
Reviews

ABSTRACT

Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes—to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today’s use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients’ illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient self-determination and avoiding non-beneficial interventions at the end of life.

KEY WORDS

do-not-resuscitate orders informed consent end-of-life care 

Notes

Funding Sources

Dr. Fetters’ participation in this work was made possible in part through the generous support of the Jitsukoukai Foundation. Dr. Reid is supported by grants from the John A. Hartford foundation (Center of Excellence in Geriatric Medicine Award) and the National Institute on Aging (P30 AG22845-07).

Conflict of Interest

None disclosed.

Prior Presentations

None.

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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Jacqueline K. Yuen
    • 1
  • M. Carrington Reid
    • 1
    Email author
  • Michael D. Fetters
    • 2
  1. 1.Division of Geriatrics and GerontologyWeill Medical College, Cornell UniversityNew YorkUSA
  2. 2.Department of Family MedicineUniversity of MichiganAnn ArborUSA

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