Journal of Medical and Surgical Intensive Care Medicine 2018 , Vol 9, Issue 2
Opinions of Chest Physicians About the Do-Not-Resuscitate (DNR) Orders: Respect for Patient’s Autonomy or Medical Futility?
Esin Akgül Kalkan 1 ,Arzu Mirici 2
1Department of Forensic Medicine, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
2Department of Chest Diseases, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
DOI : 10.5152/dcbybd.2018.1874 Objective: In this study, we aimed to investigate physicians’ knowledge, attitude, and behavior related to cardiopulmonary resuscitation (CPR) and the do-not-resuscitate (DNR) order, and the factors associated with decisions to abide by patients’ DNR orders were also evaluated.

Material and Methods: An e-survey designed by the research team, based on the European Resuscitation Council Guidelines (2015), American Heart Association Guidelines (2015) for resuscitation, and the relevant literature and legal regulations, was administered to resident and specialist doctors in chest diseases. Descriptive data of the number, percentage, and the mean and standard deviation are presented. The chi-squared test was used in the analysis of categorical data. Statistical significance was accepted as p<0.05.

Results: The e-survey questions were answered by 376 physicians voluntarily. Of responders, 59.6% (n=224) were female, and the mean age was 40.2±9.0 years. Approximately 57% of physicians reported that “if a doctor has decided medical futility, not performing CPR does not constitute an ethical debate.” Responses indicated that 47.7% of physicians would abide by the DNR order. A statistically significant difference was identified between “physicians’ decision not to perform CPR” and “abiding by the patient’s DNR orders” (p<0.05). There was also a statistically significant difference between “perceiving the DNR orders as euthanasia and thinking abiding by this decision was a crime” and “abiding by patient’s DNR orders” (p<0.05).

Conclusion: In this study, we observed that two main factors are foreground in the implementation of the DNR order. The first of these is the physician’s opinion about medical futility of CPR, and the other is the lack of specific laws regarding DNR in Turkey. Defining specific legal regulations related to end-of-life decisions like DNR will aid in ensuring patient autonomy. Keywords : Resuscitation orders, medical futility, decision making, patient