Do-not-resuscitate order after 25 years*
作者:
Jeffrey Burns,
Jeffrey Edwards,
Judith Johnson,
Ned Cassem,
Robert Truog,
期刊:
Critical Care Medicine
(OVID Available online 2003)
卷期:
Volume 31,
issue 5
页码: 1543-1550
ISSN:0090-3493
年代: 2003
出版商: OVID
关键词: cardiopulmonary resuscitation refusal;do-not-resuscitate order;futility;presumed consent
数据来源: OVID
摘要:
BackgroundIn 1976, the first hospital policies on orders not to resuscitate were published in the medical literature. Since that time, the concept has continued to evolve and evoke much debate. Indeed, few initials in medicine today evoke as much symbolism or controversy as the Do-Not-Resuscitate (DNR) order.ObjectiveTo review the development, implementation, and present standing of the DNR order.DesignReview article.Main ResultsThe DNR order concept brought an open decision-making framework to the resuscitation decision and did much to put appropriate restraint on the universal application of cardiopulmonary resuscitation for the dying patient. Yet, even today, many of the early concerns remain.ConclusionsAfter 25 yrs of DNR orders, it remains reasonable to presume consent and attempt resuscitation for people who suffer an unexpected cardiopulmonary arrest or for whom resuscitation may have physiologic effect and for whom no information is available at the time as to their wishes (or those of their surrogate). However, it is not reasonable to continue to rely on such a presumption without promptly and actively seeking to clarify the patient’s (or surrogate’s) wishes. The DNR order, then, remains an inducement to seek the informed patient’s directive.
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