Would physicians override a do-not-resuscitate order when a cardiac arrestis iatrogenic?

OBJECTIVE:To assess whether physicians would be more likely to override a d o-not-resuscitate (DNR) order when a hypothetical cardiac arrest is iatroge nic. DESIGN: Mailed survey of 358 practicing physicians. SETTING:A university-affiliated community teaching hospital, PARTICIPANTS:Of 358 physicians surveyed, 285 (80%) responded. MEASUREMENTS AND MAIN RESULTS: Each survey included three case descriptions in which a patient negotiates a DNR order, and then suffers a cardiac arre st. The arrests were caused by the patient's underlying disease, by an unex pected complication of treatment, and by the physician's error. Physicians were asked to rate the likelihood that they would attempt cardiopulmonary r esuscitation for each case description. Physicians indicated that they woul d be unlikely to override a DNR order when the arrest was caused by the pat ient's underlying disease (mean score 2.55 on a scale from 1 "certainly wou ld not" to 7 "certainly would"). Physicians reported they would be much mor e likely to resuscitate when the arrest was due to a complication of treatm ent (5.24 vs 2.55; difference 95% confidence interval [CI] 2.44, 2.91; p <. 001), and that they would be even more likely to resuscitate when the arres t was due to physician error (6.32 vs 5.24; difference 95% CI 0.88, 1.20; p <.001). Eight percent, 29%, and 69% of physicians, respectively, said that they "certainly would" resuscitate in these three vignettes (p <.001). CONCLUSIONS: Physicians may believe that DNR orders do not apply to iatroge nic cardiac arrests and that patients; do not consider the possibility of a n iatrogenic arrest when they negotiate a DNR order. Physicians may also be lieve that there is a greater obligation to treat when an illness is iatrog enic, and particularly when an illness results from the physician's error. This response to iatrogenic cardiac arrests, and its possible generalizatio n to other iatrogenic complications, deserves further consideration and dis cussion.