Skip to main content

Resuscitation and Ethics: How to Deal with the “Do not Resuscitate Order”?

  • Chapter
  • First Online:
Resuscitation

Abstract

Resuscitation has the ability to reverse premature death but it can also prolong terminal illness, increase discomfort, and consume resources. Do Not Resuscitate (DNR) Order and Advance Directives (ADs) are still a debated issue in critical care. Worldwide there is a variety of policies, attitudes, and beliefs that are different among countries. It is well known about the variety of thoughts and religious thinking in the community and this is what justify the different ethical principles and a missing common law. To face the “end of care” issue and to achieve a consensus we believe in the priority of continuing education and training programs for health care professionals. Moving up the reflection on ethical values and principles useful to understand definition of medical professionalism, it could be possible to undertake the right way to avoid futile and aggressive care. To improve the attitude about DNR order it will be necessary to achieve several goals such as: increasing communication, consensus on law, increasing trust among patient and health care system, improving standards and quality of care, to respect patient’s will and family’s role.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vincent JL (2005) Outcome and ethics in severe brain damage. Prog Brain Res 150:555–563

    Article  PubMed  Google Scholar 

  2. Payne JK, Thornlow DK (2008) Clinical perspectives on portable do-not-resuscitate orders. J Gerontol Nurs 34(10):11–16

    Article  PubMed  Google Scholar 

  3. The Ethics Committee of the Society of Critical Care Medicine (1997) Consensus statement of the society of critical care medicine’s ethics committee regarding futile and other possibly inadvisable treatments. Crit Care Med 25:887–891

    Article  Google Scholar 

  4. Curtis JR, Burt RA (2007) Point: the ethics of unilateral “do not resuscitate” orders: the role of “informed assent”. Chest 132(3):748–751

    Article  PubMed  Google Scholar 

  5. Kierzek G, Rac V, Pourriat JL (2010) Advance directives and surrogate decision making before death. N Engl J Med 363(3):295

    Article  PubMed  CAS  Google Scholar 

  6. Curtis JR, Vincent JL (2010) Ethics and end-of-life care for adults in the intensive care unit. Lancet 376(9749):1347–1353

    Article  PubMed  Google Scholar 

  7. Guo Y, Palmer JL, Bianty J et al (2010) Advance directives and do-not-resuscitate orders in patients with cancer with metastatic spinal cord compression: advanced care planning implications. J Palliat Med 13(5):513–517

    Article  PubMed  Google Scholar 

  8. Venneman SS, Narnor-Harris P, Perish M et al (2008) “Allow natural death” versus “do not resuscitate”: three words that can change a life. J Med Ethics 34(1):2–6

    Google Scholar 

  9. National Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) (1986) Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Part VIII: medicolegal considerations and recommendations. JAMA 255(21):2979–2984

    Google Scholar 

  10. Stephen SS, Doukas DJ (2009) Advance directives. The penn center guide to bioethics. Springer, pp 749–754

    Google Scholar 

  11. Truog RD (1991) Do-not-resuscitate orders during anesthesia and surgery. Anesthesiology 74:606–608

    Article  PubMed  CAS  Google Scholar 

  12. American society of anesthesiologists ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit care (1998) American Society of Anesthesiologists 1999 Directory of Members. American Society of Anesthesiologists, Park Ridge, pp 470–471

    Google Scholar 

  13. Holley A, Kravet SJ, Cordts G (2009) Documentation of code status and discussion of goals of care in gravely ill hospitalized patients. J Crit Care 24(2):288–292

    Article  PubMed  Google Scholar 

  14. Cohen RI, Lisker GN, Eichorn A et al (2009) The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit. J Crit Care 24(2):311–315

    Article  PubMed  Google Scholar 

  15. Vincent JL, Berré J, Creteur J (2004) Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective. Chron Respir Dis 1(2):115–120

    Article  PubMed  CAS  Google Scholar 

  16. Van den Block L, Deschepper R, Bilsen J et al (2009) Euthanasia and other end of life decisions and care provided in final three months of life: nationwide retrospective study in Belgium. BMJ 339:b2772

    Article  PubMed  Google Scholar 

  17. SIAARTI—Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care Bioethical Board (2006) End-of-life care and the intensivist: SIAARTI recommendations on the management of the dying patient. Minerva Anestesiol 72:927–963

    Google Scholar 

  18. Jaing TH, Tsay PK, Fang EC et al (2007) “Do-not-resuscitate” orders in patients with cancer at a children’s hospital in Taiwan. J Med Ethics 33(4):194–196

    Article  PubMed  Google Scholar 

  19. Shetty P (2010) The parlous state of palliative care in the developing world. Lancet 376(9751):1453–1454

    Article  PubMed  Google Scholar 

  20. Nicholas LH, Langa KM, Iwashyna TJ et al (2011) Regional variation in the association between advance directives and end-of-life Medicare expenditures. JAMA 306(13):1447–1453

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cristina Santonocito .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Santonocito, C., Sanfilippo, F., Ristagno, G., Gullo, A. (2014). Resuscitation and Ethics: How to Deal with the “Do not Resuscitate Order”?. In: Gullo, A., Ristagno, G. (eds) Resuscitation. Springer, Milano. https://doi.org/10.1007/978-88-470-5507-0_22

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5507-0_22

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5506-3

  • Online ISBN: 978-88-470-5507-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics