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How to approach DNAR and other end of life decisions

Dr Malik: The BMJ articles in the 11th March 2017 issue provide good guidance on how to broach difficult questions:

What do you understand about your condition?

What do you expect to happen?

What if you suddenly get more unwell?

What is important for you in the future? Comfort, length of life at all costs?

Then we can chat about resuscitation (CPR) or not (DNAR order), but also other treatments, including surgery, antibiotics.

This is a good way to deal with it. All doctors should read it, and all patients should expect it. It is not black and white.

About 80-90% of patients dying in hospital have DNAR orders in place. BUT most patients with DNAR orders in place go home alive. Perhaps the name is the problem? Recommended Summary Plan for Emergency Care and Treatment (ReSPECT; www.respectprocess.org.uk): a ReSPECT form may be better.

http://www.bmj.com/content/356/bmj.j813

http://www.bmj.com/content/356/bmj.j876

 

Posted on 11 March 2017
Author: Hafsa Malik
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