Thursday, December 30, 2010

Partial DNR orders: always patient centered, often irrational, maybe harmful

In the era of patient centered care it's fashionable during DNR discussions to let people pick and choose from a menu of interventions, often resulting in “partial DNR” decisions. In some cases irrational combinations of interventions are chosen despite efforts to educate patients and family members on the rationale and expectations for various treatment modalities.

A recent paper in Critical Care Medicine reviewed the literature on partial DNR orders. Based on the limited published experience the authors suggested that the practice was “clinically and ethically problematic” and concluded:

Discouraging partial do-not-resuscitate(s) order may help promote more accurate and comprehensive advance care planning.

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