Do not attempt resuscitation orders: the role of clinical governance

Abstract

Purpose

The purpose of this paper is to provide a viewpoint on decision making in do not attempt resuscitation (DNAR) orders from the perspective of a competent patient who requests cardiopulmonary resuscitation (CPR) when their clinical prognosis is poor. This issue will be examined from the position of patient autonomy and self determination.

Design/methodology/approach

The literature is reviewed including academic commentary, case law and statute.

Findings

The paper finds that factors such as futility and quality of life that engage in DNAR considerations should be gauged from the patient's perspective. There is a definite argument for supporting a competent patient's positive autonomous choice for CPR. This should feature clearly within the framework of clinical governance.

Research limitations/implications

Presents a viewpoint designed to stimulate debate based on a contemporary perspective of patient autonomy.

Practical implications

End‐of‐life care is assuming a greater importance as evidenced by an increase in reported complaints. Decisions regarding CPR need to form part of the clinical governance agenda.

Originality/value

This paper provides an original viewpoint on the tension between a competent positive choice for CPR against opposing medical opinion, and argues for a resolution on a principled basis to protect patients from arbitrary decision making with regard to resuscitation.

Citation

Samanta, A. and Samanta, J. (2008), "Do not attempt resuscitation orders: the role of clinical governance", Clinical Governance: An International Journal, Vol. 13 No. 3, pp. 215-220. https://doi.org/10.1108/14777270810892638