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Deconstructing DNR
  1. Brian D Gelbman,
  2. Joy M Gelbman
  1. Weill Cornell Medical Center, New York, New York, USA
  1. Dr Brian D Gelbman, 635 Madison Avenue, Suite 1101, New York, NY 10022, USA; brg9001{at}nyp.org

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Our hospital routine requires that all new admissions must be asked about their code status. It is not uncommon for an otherwise healthy patient to request that a do-not-resuscitate (DNR) order be placed in their chart. Presumably, these patients who wish to have a DNR order are acting on the belief that should an unforeseen, irreversible condition occur that leads to a cardiac arrest, they would not want to undergo resuscitation. Tragically, we have witnessed several instances in which potentially life-saving interventions were withheld in viable patients in non-arrest settings for reversible conditions (eg, intubation for nosocomial pneumonia) because the patients had a DNR order in the chart. Unfortunately, this happens when the treating physicians are not aware of the limited scope of a DNR order and instead use the order as a blanket prohibition against all components of resuscitation. This communication failure is due to misconceptions that patients and their physicians have with regard to such orders. The medical community is well overdue to improve the end-of-life decisions offered to patients beyond relying on the outdated term DNR.

LIMITATIONS OF DNR ORDERS

Despite the major advances in critical care medicine in the past few decades, doctors have not substantially improved their ability to address end-of-life decisions any better than by using the all-encompassing term DNR. Currently, the term is generally accepted as an order to prohibit the use of interventions to reverse a cardiac or pulmonary arrest.1 2 What is frequently forgotten with the DNR order is that …

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