Increasing Use of DNR Orders in the Elderly Worldwide: Whose Choice is it?

• Author: Cherniack, E.P.
• Position: Abstracts

E. P. Cherniack, Increasing Use of DNR Orders in the Elderly Worldwide: Whose Choice is it? 28 J. MED. ETHICS 303 (2002).

There is evidence to suggest that while many elderly patients favor resuscitation, they die with DNR (do-not-resuscitate) orders in place. In limited data from other countries, the majority of older persons in the United Kingdom and Israel desired CPR (cardio-pulminary resuscitation). The choice of a DNR order can be influenced, however, by the way in which CPR is presented. Physician bias might alter patient decisionmaking. At least one study confirmed the commonsense notion that when information about CPR is presented more negatively, fewer elderly will choose it. There is also some evidence that individuals prefer the first option if several are explained to them. While CPR survival rates and predictors of survival from CPR are known, more studies should be done to ascertain when and how the elderly prefer to be asked about resuscitation, how much and what type of care they want at the end of their lives, and how and where they wish to die.

Since several studies have indicated that physicians sometimes disregard DNR orders, apply CPR reluctantly, and...