DNR Best Practices?

Rosemary Flanigan
April 1, 2009

Remember my telling you about the patient with terminal renal cell carcinoma who is incompetent, has had a guardian appointed, and the team of 7 physicians caring for him thought it appropriate to have a Do Not Resuscitate Order.

I heard this morning that he has it!!! The ethics committee, after discussing “at length the various legal, moral, and ethical reasons both for and against instituting a DNR when the patient no longer possesses the decisional capacity to decide for himself,” concluded that the 2 physician specialists would co-sign the DNR and that the team leader would write a treatment plan to be shared with unit staff regarding what measures would or would not be taken in the event of a medical emergency.

Personally, I think that was a defensible outcome; I assume that the guardian agreed. Amazingly, during the course of all this, they were able to find family members whom he had not seen in 5 years and who were satisfied with the DNR and the treatment plan.

My peek into the future of healthcare reform tells me that there will be more DNR orders initiated and encouraged by physicians along with patient/family proposals. What my “peek” doesn’t tell me if whether or not there will be some “best practice” guidelines that will simply mandate a DNR order, regardless of physician OR patient OR family concurrence.

What do you think?