Stories about: do-not-resuscitate orders

DNR orders and end-of-life decisions for children: The elephant in the room

End of life decisions: The elephant in the roomAmy Sanderson, MD, is a critical care physician at Boston Children’s Hospital whose research interests include developing and studying interventions to improve the quality of communication among clinicians, parents and children with life-threatening illnesses.

Do-Not-Resuscitate (DNR) orders are supposed to tell clinicians what not to do should a patient stop breathing or his heart stop beating (cardiopulmonary arrest). But our research in children with life-threatening illness reveals that DNR orders often are used in variable, unintended ways that, while well-intentioned, are problematic.

We surveyed physicians and nurses practicing in oncology, the intensive care unit (ICU) and the cardiac ICU—settings where end-of–life decisions typically take place. Of our 266 respondents, 67 percent agreed that a DNR order should guide medical decisions only during a cardiopulmonary arrest. Yet, in reality, their responses indicate that DNR orders influence care much more broadly.

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