Do not resuscitate decisions: flogging dead horses or a dignified death? [Editorial]
Evidence suggests that doctors may be using "do not resuscitate" orders to uphold their own prejudices and this reduces quality of care, writes Shah Ebrahim from the University of Bristol's Department of Social Medicine, in this week's BMJ.
Citing research published in America, Professor Ebrahim writes that over two thirds of patients with "do not resuscitate" (DNR) orders have not been involved in making these decisions. And DNR patients are 30 times more likely to die than other patients, irrespective of the severity of their illness or other risk factors, he says. US data show that DNR orders tend to be used for patients who are black, alcoholic, non-English speakers, or who have HIV. This suggests, writes Professor Ebrahim, that doctors operate on stereotypes of whose life is worth saving.
In the UK guidance from the BMA, the Resuscitation Council and the Royal College of Nursing is regularly flouted, and ageism is alive and well in the NHS when it comes to DNR, contends Professor Ebrahim. Audit and education over the past 30 years have done little to stem prejudice in the health service against the elderly, he says. Legislation outlawing the practice looks to be the only solution, he concludes.
Professor Shah Ebrahim, Department of Social Medicine, University of Bristol Email: email@example.com