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Ethical issues surrounding do not attempt resuscitation orders: decisions, discussions and deleterious effects
  1. Zoë Fritz,
  2. Jonathan Fuld
  1. Cambridge University Hospitals NHS Foundation Trust, UK
  1. Correspondence to Dr Zoë Fritz, Department of Acute Medicine, Cambridge University NHS Foundation Trust, Box 275, Hills Road, Cambridge, CB2 0QQ, UK; zoefritz{at}gmail.com

Abstract

Since their introduction as ‘no code’ in the 1980s and their later formalisation to ‘do not resuscitate’ 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 paper 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.

  • Attitude of health personnel
  • attitudes towards death
  • ethics
  • quality of health care
  • resuscitation orders

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Footnotes

  • Funding The National Institute for Health Research, Research for Patient Benefit Programme supported this study, but has had no direct involvement in the writing of this paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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