DECIDING NOT TO RESUSCITATE IN DUTCH HOSPITALS

The use of do not resuscitate (DNR) orders in Dutch hospitals was stud ied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, a nd 61 per cent of all in-hospital deaths were preceded by a DNR decisi on. We found that in only 14 per cent of the cases had the patients be en involved in the DNR decision (32 per cent of competent patients). T he concept of futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a med ical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patien t involvement gave many reasons for their decision that went beyond de termining effectiveness, we conclude that more patient involvement wou ld have been desirable.