Docs May Overinterpret Do-Not-Resuscitate Orders


New York, NY — New research suggests that some doctors may too-broadly interpret the “do-not-resuscitate” (DNR) orders that some patients choose near the end of their lives.

DNR orders direct doctors to withhold cardiopulmonary resuscitation (CPR) from seriously ill patients in the event of cardiac arrest. But in the new study, researchers found that doctors may be willing to forgo other types of potentially life-prolonging treatments when a patient has a DNR order.

“Although patients who choose (the DNR) option may also choose to forgo other life-sustaining interventions, a DNR order is not intended to apply to any treatment other than CPR,” write the study authors, Dr. Mary Catherine Beach of Johns Hopkins University in Baltimore, Maryland, and Dr. R. Sean Morrison of the Mount Sinai School of Medicine in New York City.

Their findings are published in the December issue of the Journal of the American Geriatrics Society.

For the study, the researchers surveyed 241 physicians, outlining three vignettes involving patients with life-threatening illness such as advanced cancer or AIDS complicated by pneumonia. Some doctors were informed that all of the patients had a DNR order, while the others were told that none did.

The investigators found that for all three patients, doctors were more likely to forgo CPR and other life-sustaining treatments when they were told there was a DNR order. Although the physicians said they would attempt various treatments for these patients, overall they would try fewer therapies when there was a DNR order.

“Physicians are less likely to agree to initiate procedures ranging from complex therapies, such as intensive care unit transfer, to simpler interventions, such as blood transfusions,” write Beach and Morrison. “These decisions should not be based on the DNR order alone.”

The authors recommend that doctors make more of an effort to discuss broad goals of therapy with patients so that more specific decisions and end-of-life instructions can be made.

What's more, they write, physicians should undergo more rigorous education on how to talk with patients about end-of-life care.

The report can be found in the Journal of the American Geriatrics Society 2002:50.

(This article courtesy of Steven Ertelt and the Pro-Life Infonet email newsletter. For more information or to subscribe go to www.prolifeinfo.org or email infonet@prolifeinfo.org.)

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