The Do-Not-Resuscitate Order: Still Too Little Too Late

doi:10.1001/archinte.1990.00390170091020

You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.

Vol. 150 No. 5, May 1990

Online Only
	•	Online First Table of Contents

ORIGINAL INVESTIGATIONS

•	Online Features

This Article
•	References
•	Full text PDF
•	Reply to article
•	Send to a friend
•	Save in My Folder
•	Save to citation manager
•	Permissions

Citing Articles
•	Citation map
•	Citing articles on HighWire
•	Citing articles on Web of Science (62)
•	Contact me when this article is cited

Related Content
•	Similar articles in this journal

Social Bookmarking
	What's this?

The Do-Not-Resuscitate Order

Still Too Little Too Late

Kevin Gleeson, MD

Arch Intern Med. 1990;150(5):1057-1060.

Abstract

• We reviewed the records of 274 consecutive deaths atthe Milton S. Hershey Medical Center, Hershey, Pa, occurringthrough May 1988 to examine the approach of physicians, patients,and families in making the decision to invoke the "do-not-resuscitate"order. Of these 274 patients who died, 171 (62%) had do-not-resuscitateorders. Of these 171 patients, 86 (50%) were judged fully mentallycompetent on admission to the hospital; 44 (51%) of these 86fully competent patients were included in the decision to withholdresuscitative efforts. In the remainder, the family was usuallyinvolved in the decision without input from the patient. Only6 patients (4%) were admitted to the hospital with a preexistingdo-not-resuscitate order. For the remainder, the do-not-resuscitateorder was written a mean of 8.5 days following admission and3.3 days before death. Documentation of this order with a specificprogress note was universal. The principle reason cited fora do-not-resuscitate order was the presence of irreversibleterminal disease in 52% and an unacceptable quality of lifein 33%. When considered separately, patients with a principlediagnosis of malignant neoplasm had a do-not-resuscitate orderwritten 80% of the time. Of 88 such patients, 48 (55%) werefully competent at admission. In turn, 36 (75%) of these patientsparticipated in the do-not-resuscitate decision. Nursing activitieswere quantified for the 24 hours preceding and the 24 hoursfollowing the do-not-resuscitate order. No difference couldbe found comparing these two periods whether the comparisonwas made on the general hospital ward or in the intensive careunit. We conclude that some progress is being made as a reasonablepercentage of mentally competent patients dying in this centerare included in the decision to limit their care at the timeof death. However, this decision is only rarely considered untillate in the course of most patients' terminal hospitalization.A do-not-resuscitate order apparently does not result in a reductionin the quantity of nursing activity for patients as they die.

(Arch Intern Med. 1990;150:1057-1060)

Author Affiliations

Scott Wise

From the Department of Medicine, Pulmonary/Critical Care Division, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.

Footnotes

Accepted for publication December 13,1989.

Reprints not available.

Add to CiteULike CiteULike Add to Connotea Connotea Add to Delicious Delicious Add to Digg Digg Facebook Add to Reddit Reddit Add to Technorati Technorati Twitter What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act
Morrell et al.
J. Med. Ethics 2008;34:642-647.
ABSTRACT | FULL TEXT

Cardiopulmonary Resuscitation in Patients With Cancer
Varon and Marik
AM J HOSP PALLIAT CARE 2007;24:224-229.
ABSTRACT

Advance Care Planning in a Frail Older Population: Patient Versus Program Influences
Temkin-Greener et al.
Research on Aging 2005;27:659-691.
ABSTRACT

Improving the ICU: Part 1
Garland
Chest 2005;127:2151-2164.
ABSTRACT | FULL TEXT

Evaluation of end of life care in cancer patients at a teaching hospital in Japan
Tokuda et al.
J. Med. Ethics 2004;30:264-267.
ABSTRACT | FULL TEXT

Increasing use of DNR orders in the elderly worldwide: whose choice is it?
Cherniack
J. Med. Ethics 2002;28:303-307.
ABSTRACT | FULL TEXT

Clinical Factors That Influence Patients' Desire for Participation in Decisions About Illness
Mansell et al.
Arch Intern Med 2000;160:2991-2996.
ABSTRACT | FULL TEXT

Family Members' Experiences With Do-Not-Resuscitate (DNR)
LARSEN
Journal of Family Issues 1999;20:269-289.
ABSTRACT

Advance End-of-Life Treatment Planning
Miles et al.
Arch Intern Med 1996;156:1062-1068.
ABSTRACT

Epidemiology of Do-Not-Resuscitate Orders: Disparity by Age, Diagnosis, Gender, Race, and Functional Impairment
Wenger et al.
Arch Intern Med 1995;155:2056-2062.
ABSTRACT

Terminal Care of the Very Old: Changes in the Way We Die
Hesse
Arch Intern Med 1995;155:1513-1518.
ABSTRACT

New Do-Not-Resuscitate Policies
Small
Arch Intern Med 1994;154:1536-1539.
ABSTRACT

Myth of Substituted Judgment: Surrogate Decision Making Regarding Life Support Is Unreliable
Suhl et al.
Arch Intern Med 1994;154:90-96.
ABSTRACT

Do Not Resuscitate Orders and the Cost of Death
Maksoud et al.
Arch Intern Med 1993;153:1249-1253.
ABSTRACT

Impact of a Procedure-Specific Do Not Resuscitate Order Form on Documentation of Do Not Resuscitate Orders
Mittelberger et al.
Arch Intern Med 1993;153:228-232.
ABSTRACT

Life-Sustaining Interventions in Frail Elderly Persons: Talking About Choices
Kellogg et al.
Arch Intern Med 1992;152:2317-2320.
ABSTRACT

Factors Associated With Veterans' Decisions About Living Wills
Sugarman et al.
Arch Intern Med 1992;152:343-347.
ABSTRACT

Cardiopulmonary Resuscitation in Teaching Hospitals
Green
ANN INTERN MED 1991;115:578-578.
ABSTRACT

Advance Directives on Admission Clinical Implications and Analysis of the Patient Self-Determination Act of 1990
La Puma et al.
JAMA 1991;266:402-405.
ABSTRACT

Discussing Life-Sustaining Treatment: A Teaching Program for Residents
Gordon and Tolle
Arch Intern Med 1991;151:567-570.
ABSTRACT

| | |