36 J. Med. Ethics: Ethical Issues Surrounding Do Not Attempt Resuscitation Orders: Decisions, Discussions and Deleterious Effects.

• Author: Fritz, Zoe
• Position: Reprint

Since their introduction as "no code" is the 1980s and their later formalization to "do not resuscitate" (DNR) orders, such directions to withhold potentially life-extending treatments have been accompanied by multiple ethical issues. The arguments for when and why to instigate such orders are explored, including a consideration of the concept of futility, allocation of healthcare resources, and reaching a balance between quality of life and quality of death. The merits and perils of discussing such decisions with patients and/or their relatives are reviewed and the unintended implications of "do not attempt resuscitation" orders are examined. Finally, the article explores some alternative methods to approaching the resuscitation decision, and calls for empirical evaluation of such methods that may reduce the ethical dilemmas physicians currently face.

Ethical reasons for withholding attempted resuscitation include, but are not limited to, patient request, an attempt at avoiding a treatment that has more chance of doing harm (pain, discomfort, lack of dignity) than good (survival, but at possibly reduced quality of life), trying to provide good "quality of death" and the consideration that resources would be better used elsewhere. To be confident in using any of these reasons, however, more research is needed: in economic analysis, in survivor experience and in creating better tools to predict who...