Could it be that if a patient has already decided to not continue their life by turning down resuscitation legally, healthcare professionals should save time and money by not recommending or performing surgeries to prolong life? A new study shows that about 70% of Americans die when they have do not resuscitate (DNR) orders in place, after having potentially saving surgeries or not.
Dr. Saziana Roman, who worked on the study comments:
"The conversation that needs to be had between the patient and the doctor is, what is the greater goal, and what can you expect from having the surgery. Are you likely to end up on a ventilator or in the intensive care unit, for instance?"
Researchers contrasted the surgical outcomes for some 4,000 DNR patients with age-matched patients who'd had the same procedure done but didn't have a DNR order. Overall, nearly 25% of DNR patients died in the month following their surgery, about three times as many as in the comparison group. That difference remained even after taking into account that DNR patients are usually sicker to begin with, Roman said, although the reasons aren't clear.
DNR patients also had slightly more complications, such as pneumonia or stroke. Roman added:
"In U.S. there is a tendency to be afraid to talk about dying, and we are trained to value life above anything else. Sometimes that might actually be detrimental."
A DNR order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patient's breathing or heartbeat stops.
DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to revive the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR.
CPR, when successful, restores heartbeat and breathing and allows patients to resume their previous lifestyle. The success of CPR depends on the patient's overall medical condition. Age alone does not determine whether CPR will be successful, although illnesses and frailties that go alone with age often make CPR less successful.
When patients are seriously ill or terminally ill, CPR may not work or may only partially work, leaving the patient brain-damaged or in a worse medical state than before the heart stopped. In these cases, some patients prefer to be cared for without aggressive efforts at resuscitation upon their death.
In 1991, the U.S. Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an individual's decision in their healthcare. Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri.
In the United States, CPR and advanced cardiac life support (ACLS) will not be performed if a valid written DNR order is present. Many U.S. states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures unless a specific state sponsored form is appropriately filled out and cosigned by a physician.
Source: Archives of Surgery
Written by Sy Kraft


The doctors strongly recommended a DNR for my Grandfather when he was in hospital and put pressure on my mother to agree to it, but promised they would do everything in their power to keep him alive... This was not our choice or his... should he then have been denied the care that could have allowed him to come home? Yes he had advanced kidney failure - but we weren't ready to lose him and he was still enjoying his life.
Isn't this basically saying the same thing as the Quality of Life vs Length of Life question?
I think we already cover this... at least good doctors do. Am I wrong?
There's a big difference between a patient deciding for himself that extraordinary resuscitative means should not be taken to keep him alive, and a physician or insurance company making that decision for him. Most women understand this, having spent decades fighting for the right to decide what to do with their own bodies. When you are 85, 75, or even 65 years old, in failing health, and need extensive medical treatment, how will YOU react when your doctor says, "I'm sorry, but you're just too old for the treatment.
Your insurance company and I have discussed it, and we agree that you're a poor risk because, well, let's face it, you're going to die soon anyway." Does anyone in this country really want to give up their right to decide how and when their life will end? Do we really think a doctor or insurance company case reviewer should do it for us? I don't think so.
In the 1970s Hollywood produced a couple of movies, Soylent Green and Logan's Run, which had a theme that humans had over populated to a point of exhausting resources and forcing governments to turn to killing people when they reached a certain age. In Soylent Green, the theme also involved cannibalism--when you were killed, you'd be turned into food. At a time in human history where the human population has climbed to unsustainable levels, it looks like the US is beginning to look at age as a bad thing and perhaps deny care and benefits to those who are older. Right now the scrutiny may be those 65 and older. How long will it take for the age range to fall to the 50s or 40s? Will we get to the point of putting people to death at 30, like the fictional storyline in Logan's Run, because we can't afford to waste resouces them beyond that age?
DNR doesn't mean do not treat.
DNRs should be left completely up to the patient or the family members to decide
I think a person may die with dignity and grace if they choose to die on their own out of the hospital setting. If someone tells me i have the choice of extending my life 2-3 months with aggressive chemo or treatments, but have to spend it in the clinic, lab, x-rays, hospital, doctor's appointment, then i would say i am going on one last cruise and make me a dnr so that i may slip away gracefully at home. To each his own.
As a society.. we need to relearn what it means to have a natural death. It pains me to see patients kept alive on machines for months and the only reason why the patient isn't dead is because the family simply can't let go, yet. You are torturing your loved one. You are committing a crime against your loved one in your refusal to let them be at peace. How dare you, you selfish person. Doctors and medical professions may seem pushy only to you or your family because you cannot accept the fact that your loved one needs to be allowed to die. People really must to learn to accept death when it happens and stop prolonging 'life.' I use that term loosely to mean earthly existence via machine support.
One of the probelms is what you say the term DNR is or defines. DNR applies only to situations where a person is dead (no pulse or Not breathing) and pertains only to the act of CPR. It means nothing else. Unfortunately this dnr term is misunderstood an at times is belived to define end of life care. The problem with this study is that the post op care for these patients was probably effected or influenced by the lack of understanding of that term and these patients may have in fact died because of the lack of appropriate treatment. For Actual reasearch on the topic see the TRIAD I study in the journal of patient safety and the TRIAD II study in the Journal of Emergency Medicine
My mother had an illegal DNR. An unscrupulous nursing home obtained it without my knowledge, she had dementia. When I arrived at the emergency room, the doctor told me that they had done nothing to help her due to DNR. She never would have wanted a DNR. How do they check to see if DNR is valid? Apparently there is no legal action to be taken against the nursing home and they continue to operate. So sad and so wrong.