Objectives: To survey the attitudes of Swedish cardiologists and nurses regarding information given to patients and relatives concerning do-not-resuscitate (DNR) status.
Method: Questionnaire.
Setting: Nationwide, 2 years after the publication of a proposal of guidelines on DNR.
Subjects: 10% random sample of members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Response rate 73%.
Results: According to most Swedish cardiologists and cardiac nurses, patients and relatives should be honestly informed about a patient's DNR status if they ask for information. Almost all (97%) answered that the relatives of a noncompetent patient should be informed when they ask and (67%) believe that the relatives should be informed even if they do not ask. Most of the respondents (61%) stated that the patient, if mentally competent, should be informed about the DNR status first and decide if the information should be passed on to relatives. Only 12% of the respondents were of the opinion that if the relatives asked for this information to be withheld from the patient, this should be respected even if the patient asked for information, and 45% believed it should be respected if the patient did not ask. With reference to the latter, many (31%) were uncertain. The cardiologists and cardiac nurses expressed almost identical opinions in the matter of informing patients and relatives about DNR status.
Conclusions: Current guidelines recommend honest answers to questions and that priority should be given to the autonomy of the patient. However the guidelines do not offer any assistance when no questions are asked. In such cases, there may be an ethical conflict between two requirements: respect for the person and do not harm. Many health care professionals believe that the information could, in some cases, harm the patient. This conflict can hardly be solved by referring to more basic ethical values. More training in informing patients and relatives about delicate matters is probably required, together with more knowledge about the wishes of very ill patients.