This Article  • References  • Full text PDF  • 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 (218)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

How Are They Used and What Is Their Impact?

Susanna E. Bedell, MD; Denise Pelle, RN, MS; Patricia L. Maher, RN, MS; Paul D. Cleary, PhD

JAMA. 1986;256(2):233-237.

Abstract
We studied compliance with do-not-resuscitate (DNR) orders at a university hospital where a DNR protocol has existed since 1979. Documentation of DNR status in patient progress notes and chart orders increased through 1983. During a 12-month period (March 1983 through April 1984), we studied in detail the medical records of 521 patients who had a cardiopulmonary arrest in the hospital. Seventy-five percent (389 of 521) of these patients were designated DNR. Patients who were designated DNR were significantly more likely to be older, to have malignancy or an abnormal mental status, and to be less likely to have acute myocardial infarction, stroke, or chronic obstructive pulmonary disease than patients in whom resuscitation was attempted. Eighty-six percent of families, but only 22% of patients, were involved in the decision to designate a patient DNR. The decision to designate a patient DNR occurred late in the course of a patient's illness, often when the patient was in coma. For 28% of patients, some form of medical care was withdrawn or withheld after they were designated DNR. These data suggest that use of the DNR protocol requires changes if patients are to participate in the decision not to undergo cardiopulmonary resuscitation.

(JAMA 1986;256:233-237)

Author Affiliations
From the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School (Drs Bedell and Cleary), and the Charles A. Dana Research Institute (Dr Bedell), the Harvard-Thorndike Laboratory (Dr Bedell), and the Department of Nursing (Mss Pelle and Maher), Beth Israel Hospital, Boston.

Footnotes
Reprint requests to Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02215 (Dr Bedell).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Duration of Withdrawal of Life Support in the Intensive Care Unit and Association with Family Satisfaction
Gerstel et al.
Am. J. Respir. Crit. Care Med. 2008;178:798-804.
ABSTRACT | FULL TEXT  

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  

Content of Advance Directives for Individuals With Advanced Dementia
Triplett et al.
J Aging Health 2008;20:583-596.
ABSTRACT  

Meeting Physicians' Responsibilities in Providing End-of-Life Care
Shanawani et al.
Chest 2008;133:775-786.
ABSTRACT | FULL TEXT  

Characteristics of deaths occurring in hospitalised children: changing trends
Ramnarayan et al.
J. Med. Ethics 2007;33:255-260.
ABSTRACT | FULL TEXT  

Medical and Ethical Aspects of Long-term Enteral Tube Feeding
McMahon et al.
Mayo Clin Proc. 2005;80:1461-1476.
ABSTRACT  

End-of-life care: Perspectives of family members of deceased patients
Marco et al.
AM J HOSP PALLIAT CARE 2005;22:26-31.
ABSTRACT  

End of life decisions: attitudes of Finnish physicians
Hilden et al.
J. Med. Ethics 2004;30:362-365.
ABSTRACT | FULL TEXT  

The Quality of Care Plans for Patients With Do-Not-Resuscitate Orders
Sulmasy et al.
Arch Intern Med 2004;164:1573-1578.
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  

Do-Not-Resuscitate Orders in Patients Hospitalized With Acute Myocardial Infarction: The Worcester Heart Attack Study
Jackson et al.
Arch Intern Med 2004;164:776-783.
ABSTRACT | FULL TEXT  

Ethical Issues in Geriatrics: A Guide for Clinicians
Mueller et al.
Mayo Clin Proc. 2004;79:554-562.
ABSTRACT  

Finnish Nurses' Views on End-of-Life Discussions and a Comparison with Physicians' Views
Hilden et al.
Nurs Ethics 2004;11:165-178.
ABSTRACT  

Informed Consent and Advance Directives
Baruch
J. Am. Podiatr. Med. Assoc. 2004;94:198-205.
ABSTRACT | FULL TEXT  

Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital
Junod Perron et al.
J. Med. Ethics 2002;28:364-367.
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  

Discussions of "code status" on a family practice teaching ward: What barriers do family physicians face?
Calam et al.
CMAJ 2000;163:1255-1259.
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  

Barriers to Completion of Health Care Proxies: An Examination of Ethnic Differences
Morrison et al.
Arch Intern Med 1998;158:2493-2497.
ABSTRACT | FULL TEXT  

Resuscitation Preferences Among Patients With Severe Congestive Heart Failure : Results From the SUPPORT Project
Krumholz et al.
Circulation 1998;98:648-655.
ABSTRACT | FULL TEXT  

Communicating Do-Not-Resuscitate Orders With a Computer-Based System
Heffner et al.
Arch Intern Med 1998;158:1090-1095.
ABSTRACT | FULL TEXT  

Variation in the Use of Do-Not-Resuscitate Orders in Patients With Stroke
Shepardson et al.
Arch Intern Med 1997;157:1841-1847.
ABSTRACT  

Not for Resuscitation: two decades of challenge for nursing ethics and practice
Schultz
Nurs Ethics 1997;4:227-238.
ABSTRACT  

Marked Improvement in Recognition and Completion of Health Care Proxies: A Randomized Controlled Trial of Counseling by Hospital Patient Representatives
Meier et al.
Arch Intern Med 1996;156:1227-1232.
ABSTRACT  

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

The Use of Living Wills at the End of Life: A National Study
Hanson and Rodgman
Arch Intern Med 1996;156:1018-1022.
ABSTRACT  

The Impact of Do-Not-Resuscitate and Patient Care Category Policies on CPR and Ventilator Support Rates
Davila
Arch Intern Med 1996;156:405-408.
ABSTRACT  

Good Care of the Dying Patient
Council on Scientific Affairs, American Medical As et al.
JAMA 1996;275:474-478.
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  

Surrogates' Predictions of Seriously Ill Patients' Resuscitation Preferences
Layde et al.
Arch Fam Med 1995;4:518-523.
ABSTRACT  

Decisions About Life-Sustaining Treatment: Impact of Physicians' Behaviors on the Family
Tilden et al.
Arch Intern Med 1995;155:633-638.
ABSTRACT  

Use of the Medical Futility Rationale in Do-Not-Attempt-Resuscitation Orders
Curtis et al.
JAMA 1995;273:124-128.
ABSTRACT  

Limitations and Withdrawals of Medical Intervention in Pediatric Critical Care
Levetown et al.
JAMA 1994;272:1271-1275.
ABSTRACT  

Can We Talk? Inpatient Discussions About Advance Directives in a Community Hospital: Attending Physicians' Attitudes, Their Inpatients' Wishes, and Reported Experience
Reilly et al.
Arch Intern Med 1994;154:2299-2308.
ABSTRACT  

Implementing Advance Directives in the Primary Care Setting
Markson et al.
Arch Intern Med 1994;154:2321-2327.
ABSTRACT  

Evaluation of a Treatment Limitation Policy With a Specific Treatment-Limiting Order Page
O'Toole et al.
Arch Intern Med 1994;154:425-432.
ABSTRACT  

The Economics of Dying -- The Illusion of Cost Savings at the End of Life
Emanuel and Emanuel
NEJM 1994;330:540-544.
FULL TEXT  

Increasing the Completion of the Durable Power of Attorney for Health Care: A Randomized, Controlled Trial
Rubin et al.
JAMA 1994;271:209-212.
ABSTRACT  

Do-Not-Resuscitate Orders in Intensive Care Units: Current Practices and Recent Changes
Jayes et al.
JAMA 1993;270:2213-2217.
ABSTRACT  

The Specification of Levels of Active Intervention in a Chronic Care Hospital
Hirdes and Martin
Journal of Applied Gerontology 1993;12:125-138.
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  

The Illusion of Patient Choice in End-of-Life Decisions
Orentlicher
JAMA 1992;267:2101-2104.
 

Decisions for and Against Resuscitation in an Acute Geriatric Medicine Unit Serving the Frail Elderly
Torian et al.
Arch Intern Med 1992;152:561-565.
ABSTRACT  

How Strictly Do Dialysis Patients Want Their Advance Directives Followed?
Sehgal et al.
JAMA 1992;267:59-63.
ABSTRACT  

The Patient Self-Determination Act and the Future of Advance Directives
Greco et al.
ANN INTERN MED 1991;115:639-643.
ABSTRACT  

Changes in Physician Attitudes Toward Limiting Care of Critically Ill Patients
Goetzler and Moskowitz
Arch Intern Med 1991;151:1537-1540.
ABSTRACT  

Incidence and Characteristics of Preventable latrogenic Cardiac Arrests
Bedell et al.
JAMA 1991;265:2815-2820.
ABSTRACT  

Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders
Council on Ethical and Judicial Affairs, American
JAMA 1991;265:1868-1871.
ABSTRACT  

Life-Sustaining Therapy: A Model for Appropriate Use
Murphy and Matchar
JAMA 1990;264:2103-2108.
ABSTRACT  

The Do-Not-Resuscitate Order: Still Too Little Too Late
Gleeson
Arch Intern Med 1990;150:1057-1060.
ABSTRACT  

Ethical Principles in Critical Care
Luce
JAMA 1990;263:696-700.
ABSTRACT  

Cardiopulmonary Resuscitation Policies and Practices: A Statewide Nursing Home Study
Brunetti et al.
Arch Intern Med 1990;150:121-126.
ABSTRACT  

Outcomes of Cardiopulmonary Resuscitation in the Elderly
Murphy et al.
ANN INTERN MED 1989;111:199-205.
ABSTRACT  

Evaluation of the Do Not Resuscitate Orders at a Community Hospital
Stolman et al.
Arch Intern Med 1989;149:1851-1856.
ABSTRACT  

The Inexact Use of Fisher's Exact Test in Six Major Medical Journals
McKinney et al.
JAMA 1989;261:3430-3433.
ABSTRACT  

Life-Sustaining Treatment: A Prospective Study of Patients With DNR Orders in a Teaching Hospital
La Puma et al.
Arch Intern Med 1988;148:2193-2198.
ABSTRACT  

Ethics Committees and Decisions to Limit Care: The Experience at the Massachusetts General Hospital
Brennan
JAMA 1988;260:803-807.
ABSTRACT  

Do-Not-Resuscitate Orders
Cameron and Mernick
JAMA 1986;256:2677-2677.
ABSTRACT