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An Appraisal Of Do-not-resuscitate (dnr) Orders
Engin BAŞTÜRK*
* Dr., Marmara Üniversitesi Tıp Fakültesi Deontoloji AD, İSTANBUL
Cardiopulmonary resuscitation (CPR) is routinely performed on hospitalized patients who suffer cardiac or respiratory arrest.As other treatment modalities CPR has also some objectives; saving life, decreasing pain, return patient to previous health state. Additionally CPR has unique aim to prevent clinical death. With use of CPR we can not reach these objectives mostly. A review of 13266 cases reported in medikal literature between 1960 and 1980 revealed that 39% of hospitalized patients who received CPR initially survived the procedure, and 17% survived until they were discharged from the hospital. Nowadays CPR is used in almost all patients and also in patients who have little chance of surviving for more than a brief period of time.The questions; when do we use CPR , or when we do not use CPR, are started to be asked frequently. Physicians, patients, patients' relatives, patients' surrogates, and attorneys have the most important responsibility for witholding CPR. Witholding CPR is very difficult decision for physician because physicians have responsibilities about law. On the other end they ethical and moral values which also affect physician's decision. In order to minimize these difficulties patients themselves, if they are not capable of making decision, surrogate decision maker, or if thereis no surrogate physician should make consultation with Hospital Ethical Committees. All these decisions should be made according to patients' values and best interests.Keywords: DNR; CPR; Ethical CommitteeTurkiye Klinikleri J Med Ethics-Hukuku-Tarihi 2003, 11:12-21
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