Do Not Resuscitate (or DNR) orders have become fairly common. A lot of people when they arrive at the hospital have DNR orders, even healthy people. Some of these DNR orders reflect very ill, older patients, and in other cases, they reflect younger patients with fears that they could end up in an irreversible coma after a motor accident. These latter DNR orders do not really apply to almost everyone who comes in to the hospital for routine illnesses, as they can in most cases completely recover, even if they need short term respiratory or cardiovascular support.
Lots of ethical questions exist, one of which is do physicians treat people who come in the hospital with a DNR order differently from those who do not have a DNR order. Could you get different or less care? A study published in the Journal of the American Medical Association, looks at people who have DNR orders when they go into the hospital and need surgery compared with people who were similarly matched in their health status to see what happens to those without DNR orders, within 30 days of their surgery.
The researchers found that almost three times, 23% of those people with DNR orders, died within a month after surgery, compared with 8% of those who didn’t have these orders. Those with DNR orders are probably sicker and feel more content with the idea of death, and maybe they are even thinking more about that in the wake of their surgery. This alone would not be too surprising, but it is also possible that doctors treat these patients a little differently.
The take-home point here is that we need to really take another look at DNR orders and get serious about asking people if that’s really what they want when they come into the hospital and have reversible medical conditions. If something happened to them within the thirty days that maybe isn’t an end-of-life issue, would they or you really want the DNR order? We just don’t know if doctors are treating these patients with DNR orders differently.
It’s a complicated conversation to have with patients and an issue that we would really like to delve deeper, so look for this topic to show up in one of our upcoming shows!