Is DNR (do not resuscitate) a good idea?

Absolutely if it is what the patient wants and they have accepted the fact that they are dying from a terminal illness and do not want to have their life sustained by artificial means. Some terminal patients aren't ready to accept their mortality and do not wish to be a DNR patient. However in many of the cases I have worked as their illness progresses they decide to become DNR.

I don't think that there is a right or wrong answer to this question. It's a question of whether a terminally ill or otherwise fragile patient wants extreme measures taken. If I was terminally ill, I would want to have a DNR order because I wouldn't want to end up comatose and intubated and on a feeding tube, etc... if there was no hope for recovery!

It's a very difficult and personal decision.......

YES!!! In most cases you will eventually be on artificial means of support. It is all too common for family members to not come to an agreement to withdrawl support once the pt is critically ill, the pt is often on pressors, ventilator, and it is hard to sedate someone adequately when many sedatives cause further hypotension (morphine, propofol, etc). Therefore the pt can feel a lot of the pain and suffers unnecessarily. No one wants to be the one to "kill grandma" so the pt will suffer and often gets sepsis, bedsores, etc. I feel very strongly about getting a DNR from a pt as soon as the pt is ready to deal with the illness. It is far better to die on hospice at home, or on a regular floor, than in an ICU with broken ribs and inadequate sedation. It is also unnecessarily traumatic for the families as well. Also, if more pts were made DNR at an adequate time, we would save BILLIONS of healthcare dollars waiting for family to come to an agreement over withdrawl of support. I really see nothing that could be bad about getting someone to be a DNR.

I think that before you are able to answer that question you have to look at the individual patient and the reason for resuscitation, if you have a patient with a terminal cancer which is slow growing and is managing to maintain a bit of normailty then maybe yes resuscitation is appropriate. If your talking about a patient who is an end stage disease who is requiring large amounts of pain medication then of course DNAR is appropriate.

we have some very clear guidence in the UK about DNAR desicions issued from the British Medical Council and the resuscitation council UK. There is a decision making framwork on page 23 of that document which would be very useful to guide the clinician in making these decisions

DNAR decisions

The first part of the decision making is if the patient has capacity, in that case then the discussion should take place with that patient to establish thier wishes.

I wish more of my patients were DNR..I wish that someone could talk some sense into their families, that we are not providing a life of any quality to some of these patients. I mean honestly I love being able to see my patients heal and get better and transfer out. But reality is that not all of our patients are going to get better, and for them I would not want to keep torturing them. We have had one, in hospital since Nov, bouces back to ICU every couple weeks..back on the vent aspiration. Will never leave the hospital...what kind of life does this poor person live???

i am a critical care RN. I feel that doctors do a poor job in educating patients' about their end of life options. Currently in my unit at least 90% of the patients are terminal and are intubated. These patients are suffering tremendously and no one will approach the famailes and explain the options.However most of the families say they are not ready to let their loved one "go". While this is totally understandable, where does the patient's rights to comfort and dignity begin???

Yes.

I hate it when we get terminal tiny cancer patients that are full codes and you see them going down hill. We bicker about who has to do compressions if the time comes when we have patients like that.

I see many patients in renal failure, leading to multi-system failure, both in and out of ICU (if they're not already there, they're heading there...). Our Nephrology docs do a FABULOUS job of explaining the patient's status to family, but ultimately we all have to do what the family directs. It's terribly frustrating to have to run HD every day because the BUN & creatinine will not budge, or run a continuous CRRT because the patient's blood pressure will not tolerate the procedure. Not to mention that every time the procedure is done, or God forbid the system clots (which happens all the time when the blood is moving slowly) these people are losing tons of blood -- a full set of lines holds about 300ccs -- that's a full unit of RBCs!

My family knows my wishes, and I only wish everyone could or would say the same. It's amazing how many people think that medicine can help them live forever... even if 'living' means that you can only see this person for 15 minutes four times a day, and they cannot interact with you at all...

In my opinion if a pt gets to the point of needing intervention to stay alive then their condition (in this case we will use cancer as has been discussed most on this post) has progressed and their odds of recovery are not in their favor.

When my sister (50 years old and generally healthy) was diagnosed with cancer she was given 2 - 12 months with treatment (unknown with treatment). She had Metastatic Cardiac Sarcoma, very rare and not much known about it or it's treatment methods. She was asked about her choices in the even resuscitation would be needed right away. She chose to be listed as DNR. 3 chomo treatments and 3 short months later she passed away. Her decline was very rapid and had the discussion be postponed she would not have been able to make that decision for herself. My brother in law said that at the time of her passing it was the most difficult thing he had ever had to do, to sit and watch her go and have them do nothing to help her. He added that it was also the RIGHT thing for her, as she would not have wanted to live with the lack of quality to her life that would have been inevitable as well as the pain that results from intervention. She passed quickly and the grieving process was able to begin for all of us, which was much easier knowing to handle knowing "she didn't suffer".

I believe DNR should be discussed when the pt is fully able to make that decision for themselves. It is ultimately up to them and this gives them the opportunity to make that choice.

BTW, my parents are both fairly healthy and have also made their choice known and documented! long ago. They chose to do this when asked because they knew that you are not always given the chance to known when it may be an issue. Some things happen very suddenly.

Well, that's my for what it's worth. Sorry it was so long...

rags