Significance/Impact

DNR/AND orders can affect:

 Patient’s dying experience (hospital interventions)
 Economic issues (hospital charges)

It is important for people to be educated about the DNR/AND policy as there is a necessity to
ensure the patient’s rights and preferences when at a helpless state. The patients themselves can
opt for the DNR/AND order and their dying wish will be granted by the medical practitioners
after following ethical procedures. However, conflict arises once the patients themselves were
not able to give a decision as it is the family members with conflicting opinions who will have to
decide on the patient’s behalf. Thus, there is a need to aware the people about the DNR/AND
policy as the burden of deciding whether the orders should be given shifts to the family
members, and international relationships could be greatly affected. Further, DNR/AND orders
has an impact on a patient’s dying experience, length of hospital stay, exposure to potentially
critical hospital interventions, and medical charges.

There is an on-going debate as to who should give the DNR/AND order. Yet, most of the time,
doctors themselves are more likely to give such orders as they realize that, especially for the sick
or frail, lifesaving care can be more painful and debilitating in itself. A study conducted by
White, Engelberg, Wenrich, Lo, and Randall (2007) showed that families with low literacy rates
received less information about potential treatment outcomes. Oftentimes, they misunderstand
the patient’s vulnerability, leaving physicians and nurses the need to educate the family to render
a decision that involves a patient at risk.

Physicians and medical practitioners play an active role in developing DNR/AND policies. As
health care professionals, they must participate in the planning as well as the implementation of
DNR/AND orders. Ana Center for Ethics and Human Rights (2012) stated that the appropriate
use of DNR orders, together with adequate palliative end-of-life care, can prevent suffering for
many dying patients.

As mentioned by Weiss, G., Hite C. (2000), health care professionals have an obligation to
support a patient’s choice. If the patient cannot make a decision for himself as when he is
incapacitated, a family member will decide on the patient’s behalf, and the former’s decision is
still supported by the medical practitioners, provided that it does not harm or violate the latter’s
trust. Both the patient or a family member and the physicians must fully participate in
discussions involving a vulnerable patient, especially those with respect to AND/DNR orders.

ANA Center for Ethics and Human Rights. (2012). Nursing Care and Do Not Resuscitate (DNR)
and Allow Natural Death (AND) Decisions. Nursing World. Available at
https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/nursing-care-and-do-not-
resuscitate-dnr-and-allow-natural-death-decisions.pdf. (July 23, 2019).
Sulmasy, D., He, M., McAuley, R., & Ury, W. (2008). Beliefs and attitudes of nurses and
physicians about do not resuscitate orders and who should speak to patients and families about
them. Critical Care Medicine, 36(6), 1817–1822.

Weiss, G., Hite C. (2000). The do-not-resuscitate decision: the context, process, and
consequences of DNR orders. Death Studies. 24(4):307-23

White, D., Engelberg, R., Wenrich, M., Lo, B., & Randall, C. (2007). Prognostication during
physician-family discussions about limiting life support in intensive care units. Critical Care
Medicine, 35(2), 442–448.