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D.n.r Meaning

author
Maria Garcia
• Wednesday, 20 October, 2021
• 25 min read

The Fussy, or the nose pussy ”, if you will, was discovered during the coronavirus pandemic of 2020. Means “Do Not Precipitate”; slang used when drinking to acknowledge that you are going to drink a heavy load of alcohol and if you stop breathing do not want to be saved; used to speak of others who you wish if on the verge of death would not be revived.

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Contents

Referenced frequently in HBO's “The Wire”, when the cops are talking about getting phone wiretaps on their targets. A log comprising a list of numbers called on a telephone, be it a landline, cell phone, or Internet-based (IP telephony, Voice over IP), usually recorded by a D.N.R.,” dialed number recorder.

Technically, a DNR is the recording apparatus itself, but the term can denote one of a number of sets of data, e.g., intercepted text or instant messages, faxes, procured through a court-ordered electronic communications intercept. A DNR is part of communication collection equipment used by law enforcement, investigators, the government, and other entities.

Another is that law enforcement entities can remotely listen in and record conversations through remotely activated speaker/mic systems in the target's cell -- even with the phone turned off. DNR | Definition of DNR at Dictionary.com Medicine/Medical.do not resuscitate:(used in hospitals and other healthcare facilities to indicate to the staff the decision of a patient's doctors and family, or of the patient, to avoid extraordinary means of prolonging life).

The American Heritage® Sherman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Do not resuscitateOther named not attempt resuscitation, allow natural death, no code Ado-not-resuscitate order (DNR), also known as no code or allow natural death, is a legal order, written or oral depending on country, indicating that a person does not want to receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating.

Most commonly, the order is placed by a physician based on a combination of medical judgement and patient wishes and values. Interviews with 26 DNR patients and 16 full code patients in Toronto in 2006-9 suggest that the decision to choose do-not-resuscitate status was based on personal factors including health and lifestyle; relational factors (to family or to society as a whole); and philosophical factors.

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Audio recordings of 19 discussions about DNR status between doctors and patients in 2 US hospitals (San Francisco and Durham) in 2008-9 found that patients “mentioned risks, benefits, and outcomes of CPR,” and doctors “explored preferences for short- versus long-term use of life-sustaining therapy.” Survival from CPR among various groups When medical institutions explain DNR, they describe survival from CPR, in order to address patients' concerns about outcomes.

Success was 35% when bystanders used an Automated external defibrillator (AED), outside health facilities and nursing homes. In information on DNR, medical institutions compare survival for patients with multiple chronic illnesses; patients with heart, lung or kidney disease; liver disease; widespread cancer or infection; and residents of nursing homes.

Research shows that CPR survival is the same as the average CPR survival rate, or nearly so, for patients with multiple chronic illnesses, or diabetes, heart or lung diseases. Survival is about half as good as the average rate, for patients with kidney or liver disease, or widespread cancer or infection.

For people who live in nursing homes, survival after CPR is about half to three quarters of the average rate. In health facilities and nursing homes where AED's are available and used, survival rates are twice as high as the average survival found in nursing homes overall.

For each of 10 levels of illness, from healthiest to sickest, 7% to 36% of patients had DNR orders; the rest had full code. As noted above, patients considering DNR mention the risks of CPR.

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Physical injuries, such as broken bones, affect 13% of CPR patients, and an unknown additional number have broken cartilage which can sound like breaking bones. 5 to 10 more people, of each 100 survivors, need more help with daily life than they did before CPR.

5 to 21 more people, of each 100 survivors, decline mentally, but stay independent. If CPR does not revive the patient, and continues until an operating room is available, kidneys and liver can be considered for donation.

CPR revives 64% of patients in hospitals and 43% outside (ROSE), which gives families a chance to say goodbye, and all organs can be considered for donation, “We recommend that all patients who are resuscitated from cardiac arrest but who subsequently progress to death or brain death be evaluated for organ donation.” 1,000 organs per year in the US are transplanted from patients who had CPR.

Reductions in other care are not supposed to result from DNR, but they do. Some patients choose DNR because they prefer less care: Half of Oregon patients with DNR orders who filled out a POST {known as a POST (Physician Orders and Scope of Treatment) in Tennessee} wanted only comfort care, and 7% wanted full care.

60% of surgeons do not offer operations with over 1% mortality to patients with DNS. Patients with DNR therefore die sooner, even from causes unrelated to CPR.

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Other researchers confirm this pattern, using “resuscitation efforts” to cover a range of care, from treatment of allergic reaction to surgery for a broken hip. Hospital doctors do not agree which treatments to withhold from DNR patients, and document decisions in the chart only half the time.

A survey with several scenarios found doctors “agreed or strongly agreed to initiate fewer interventions when a DNR order was present. After successful CPR, hospitals often discuss putting the patient on DNR, to avoid another resuscitation.

Guidelines generally call for a 72-hour wait to see what the prognosis is, but within 12 hours US hospitals put up to 58% of survivors on DNR, and at the median hospital 23% received DNR orders at this early stage, much earlier than the guideline. The hospitals putting the fewest patients on DNR had more successful survival rates, which the researchers suggest shows their better care in general.

The patients who received DNR orders had less treatment, and almost all died in the hospital. The researchers say families need to expect death if they agree to DNR in the hospital.

Patients' most common goals include talking, touch, prayer, helping others, addressing fears, laughing. Three quarters of patients prefer longer survival over better health.

initial
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Advance directives and living wills are documents written by individuals themselves, to state their wishes for care, if they are no longer able to speak for themselves. In contrast, it is a physician or hospital staff member who writes a DNR “physician's order,” based upon the wishes previously expressed by the individual in his or her advance directive or living will.

Similarly, at a time when the individual is unable to express his wishes, but has previously used an advance directive to appoint an agent, then a physician can write such a DNR “physician's order” at the request of that individual's agent. These various situations are clearly enumerated in the “sample” DNR order presented on this page.

It should be stressed that, in the United States, an advance directive or living will is not sufficient to ensure a patient is treated under the DNR protocol, even if it is their wish, as neither an advance directive nor a living will legally binds doctors. They can be legally binding in appointing a medical representative, but not in treatment decisions.

Physician Orders for Life-Sustaining Treatment (POST) documents are the usual place where a DNR is recorded outside hospitals. A disability rights group criticizes the process, saying doctors are trained to offer very limited scenarios with no alternative treatments, and steer patients toward DNR.

They also criticize that DNR orders are absolute, without variations for context. The Mayo Clinic found in 2013 that “Most patients with DNR/DNI orders want CPR and/or intubation in hypothetical clinical scenarios,” so the patients had not had enough explanation of the DNR/DNI or did not understand the explanation.

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Medical bracelets, medallions, and wallet cards from approved providers allow for identification of DNR patients outside in home or non-hospital settings. Each state has its own DNR policies, procedures, and accompanying paperwork for emergency medical service personnel to comply with such forms of DNR.

There is a growing trend of using DNR tattoos, commonly placed on the chest, to replace other forms of DNR, but these often cause confusion and ethical dilemmas among healthcare providers. End of life (EOL) care preferences are dynamic and depend on factors such as health status, age, prognosis, healthcare access, and medical advancements.

DNR orders can be rescinded while tattoos are far more difficult to remove. DNR orders in certain situations have been subject to ethical debate.

In many institutions it is customary for a patient going to surgery to have their DNR automatically rescinded. Though the rationale for this may be valid, as outcomes from CPR in the operating room are substantially better than general survival outcomes after CPR, the impact on patient autonomy has been debated.

It is suggested that facilities engage patients or their decision makers in a 'reconsideration of DNR orders' instead of automatically making a forced decision. When a patient or family and doctors do not agree on a DNR status, it is common to ask the hospital ethics committee for help, but authors have pointed out that many members have little or no ethics training, some have little medical training, and they do have conflicts of interest in having the same employer and budget as the doctors.

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There is accumulating evidence of racial differences in rates of DNR adoption. Ethical dilemmas occur when a patient with a DNR attempts suicide and the necessary treatment involves ventilation or CPR.

In these cases it has been argued that the principle of beneficence takes precedence over patient autonomy and the DNR can be revoked by the physician. If the error is reversible only with CPR or ventilation there is no consensus if resuscitation should take place or not.

There are also ethical concerns around how patients reach the decision to agree to a DNR order. One study found that patients wanted intubation in several scenarios, even when they had a Do Not Intubate (DNI) order, which raises a question whether patients with DNR orders may want CPR in some scenarios too.

It is possible that providers are having a “leading conversation” with patients or mistakenly leaving crucial information out when discussing DNR. One study reported that while 88% of young doctor trainees at two hospitals in California in 2013 believed they themselves would ask for a DNR order if they were terminally ill, they are flexible enough to give high intensity care to patients who have not chosen DNR.

There is also the ethical issue of discontinuation of an implantable cardioverter defibrillator (ICD) in DNR patients in cases of medical futility. A large survey of Electrophysiology practitioners, the heart specialists who implant pacemakers and CDs, noted that the practitioners felt that deactivating an ICD was not ethically distinct from withholding CPR thus consistent with DNR.

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Pacemakers were felt to be unique devices, or ethically taking a role of “keeping a patient alive” like dialysis. Clinically, the vast majority of people requiring resuscitation will require intubation, making a DNI alone problematic.

This alteration is so that it is not presumed by the patient or family that an attempt at resuscitation will be successful. Since the term DNR implies the omission of action, and therefore “giving up”, a few authors have advocated for these orders to be retermed Allow Natural Death.

Others say AND is ambiguous whether it would allow morphine, antibiotics, hydration or other treatments as part of a natural death. New Zealand and Australia, and some hospitals in the UK, use the term NFL or Not For Resuscitation.

Until recently in the UK it was common to write “Not for 222” or conversationally, “Not for twos”. This was implicitly a hospital DNR order, where 222 (or similar) is the hospital telephone number for the emergency resuscitation or crash team.

But the concept of “guidance” had no consistent definition, For example, in the US, four respondents said yes, and two said no. Doctors' approaches to communication about resuscitation CountryDiscuss with patient or family Tell other doctors the decision ArgentinaRarelyOral Australians, pastoral+notes+preprinted, (2) notes AustriaHalfNotes BarbadosHalfOral+notes BelgiumHalf, rarelyNotes+electronic BrazilMostOral+notes BruneiRarelyOral+notes CanadaAlways, doctoral+notes, oral+notes+electronic, notes+preprinted ColombiaHalfOral CubaAlwaysOral DenmarkMostElectronic FranceMostPre-printed, GermanyAlwaysOral+notes+electronic Hong Longways, halftones+preprinted, oral+notes+preprinted HungaryRarelyOral IcelandRarelyNotes+electronic IndiaAlwaysNotes, oral, oral+notes IrelandMost, rarelyNotes (2) Israelis, pastoral+notes, (2) notes Japanese, pastoral, notes LebanonMostOral+notes+electronic MalaysiaRarelyNotes MaltaMostNotes New ZealandAlwaysPre-printed NetherlandsHalfElectronic (3) NorwayAlways, mayoral, notes+electronic PakistanAlwaysNotes+electronic PolandAlways, doctoral+notes, notes+preprinted Puerto RicoAlwaysPre-printed Saudi ArabiaAlways, mostPre-printed, notes+electronic, oral SingaporeAlways, most, halfPre-printed (2), oral+notes+preprinted, oral+notes+electronic, oral+preprinted South AfricaRarelyOral+notes South KoreaAlwaysPre-printed Spillways, mostPre-printed, oral+notes+electronic, oral+notes+preprinted Sri LankaMostNotes SwedenMostOral+notes+preprinted+electronic SwitzerlandMost, pastoral+notes+preprinted, oral+notes+other TaiwanHalf, rarelyNotes+preprinted+other, oral UAEHalfOral+notes UgandaAlwaysNotes, Always, footnotes, electronic, oral+electronic, oral+notes+electronic, oral+notes+preprinted+electronic DNS are not recognized by Jordan.

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Physicians attempt to resuscitate all patients regardless of individual or familial wishes. The UAE have laws forcing healthcare staff to resuscitate a patient even if the patient has a DNR or does not wish to live.

In Saudi Arabia patients cannot legally sign a DNR, but a DNR can be accepted by order of the primary physician in case of terminally ill patients. In Israel, it is possible to sign a DNR form as long as the patient is dying and aware of their actions.

DNA CPR form as used in Scotland England and Wales In England and Wales, CPR is presumed in the event of a cardiac arrest unless a do not resuscitate order is in place. If they have capacity as defined under the Mental Capacity Act 2005 the patient may decline resuscitation, however any discussion is not in reference to consent to resuscitation and instead should be an explanation.

Patients may also specify their wishes and/or devolve their decision-making to a proxy using an advance directive, which are commonly referred to as Living Wills '. Patients and relatives cannot demand treatment (including CPR) which the doctor believes is futile and in this situation, it is their doctor's duty to act in their 'best interest', whether that means continuing or discontinuing treatment, using their clinical judgment.

If the patient lacks capacity, relatives will often be asked for their opinion out of respect. The legal standing is similar to that in England and Wales, in that CPR is viewed as a treatment and, although there is a general presumption that CPR will be performed in the case of cardiac arrest, this is not the case if it is viewed by the treating clinician to be futile.

(Source: www.reportshop.co.kr)

Patients and families cannot demand CPR to be performed if it is felt to be futile (as with any medical treatment) and a DNA CPR can be issued despite disagreement, although it is good practice to involve all parties in the discussion. In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives and living wills may not be accepted by EMS as legally valid forms.

The DNR decision by patients was first litigated in 1976 in re Quinn. The New Jersey Supreme Court upheld the right of Karen Ann Quinn's parents to order her removal from artificial ventilation.

In 1991 Congress passed into law the Patient Self-Determination Act that mandated hospitals honor a person's decision in their healthcare. Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri.

Missouri has a Living Will Statute that requires two witnesses to any signed advance directive that results in a DNR/DNI code status in the hospital. In Australia, Do Not Resuscitate orders are covered by legislation on a state-by-state basis.

It does not apply to palliative care (reasonable pain relief; food and drink). An Advanced Care Directive legally defines the medical treatments that a person may choose to receive (or not to receive) in various defined circumstances.

(Source: www.slideshare.net)

It can be used to refuse resuscitation, so as avoid needless suffering. In NSW, a Resuscitation Plan is a medically authorized order to use or withhold resuscitation measures, and which documents other aspects of treatment relevant at end of life.

The plan allows for the refusal of any and all life-sustaining treatments, the advance refusal for a time of future incapacity, and the decision to move to purely palliative care. In Italy DNR is included in the Italian law no.

219 of December 21st 2017 “Disposition Anticipate DI Trattamento” or DAT, also called “biotestamento”. The law no.219 “Rules on informed consent and advance treatment provisions”, reaffirm the freedom of choice of the individual and make concrete the right to health protection, respecting the dignity of the person and the quality of life.

The DAT are the provisions that every person of age and capable of understanding and wanting can express regarding the acceptance or rejection of certain diagnostic tests or therapeutic choices and individual health treatments, in anticipation of a possible future inability to self-determine. To be valid, the DAT's must have been drawn up only after the person has acquired adequate medical information on the consequences of the choices he intends to make through the DAT.

With the entry into force of law 219/2017, every person of age and capable of understanding and willing can draw up his DAT. Furthermore, the DAT's must be drawn up with: public act authenticated private writing simple private deed delivered personally to the registry office of the municipality of residence or to the health structures of the regions that have regulated the DAT Due to particular physical conditions of disability, the DAT can be expressed through video recording or with devices that allow the person with disabilities to communicate.

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They can be renewed, modified or revoked at any time, with the same forms in which they can be drawn up. With the DAT it is also possible to appoint a trustee, as long as he is of age and capable of understanding and willing, who is called to represent the signatory of the DAT who has become incapable in relations with the doctor and health facilities.

With the Decree of 22 March 2018, the Ministry of Health established a national database for the registration of advance treatment provisions. In Taiwan, patients sign their own DNR orders, and are required to do so to receive hospice care.

Typically, the time period between signing the DNR and death is very short, showing that signing a DNR in Taiwan is typically delayed. Two witnesses must also be present in order for a DNR to be signed.

DNR orders have been legal in Taiwan since May 2000 and were enacted by the Hospice and Palliative Regulation. Also included in the Hospice and Palliative Regulation is the requirement to inform a patient of their terminal condition, however, the requirement is not explicitly defined leading to interpretation of exact truth telling.

In Japan, DNR orders are known as Do Not Attempt Resuscitation (DEAR). Currently, there are no laws or guidelines in place regarding DEAR orders, but they are still routinely used.

(Source: www.slideshare.net)

In addition, it is common for Japanese doctors and nurses to be involved in the decision-making process for the DEAR form. In 2005, France implemented its “Patients' Rights and End of Life Care” act.

This act allows the withholding/withdrawal of life support treatment and as well as the intensified usage of certain medications that can quicken the action of death. The “Patients' Rights and End of Life Care” Act includes three main measures.

First, it prohibits the continuation of futile medical treatments. Secondly, it empowers the right to palliative care that may also include the intensification of the doses of certain medications that can result in the shortening the patient's life span.

^ Anderson WE, Chase R, Partial SZ, Tulsa JA, Auerbach AD (April 2011). “Code status discussions between attending hospitalist physicians and medical patients at hospital admission”.

^ a b Ehrenreich WE, Barney AE, Curtis JR, Greater W, Hopewell TD, Day RA, Staple ton RD (July 2009). ^ Care HT, Zhang W, REA TD (June 2007).

“Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest”. ^ a b c d e Merchant RM, Berg RA, Yang L, Becker LB, Greenfield PW, Chan PS (January 2014).

^ Bruce JT, Wong SL, Chan PS, Bradley SM, Nallamothu BK (October 2017). “Patterns of Resuscitation Care and Survival After In-Hospital Cardiac Arrest in Patients With Advanced Cancer”.

^ Abbot ED, Yuan TC, Burmese L, Geocoding R, Volcanoes AE, Kiddie J, Edilson DP (January 2013). “Cardiopulmonary resuscitation outcomes in hospitalized community-dwelling individuals and nursing home residents based on activities of daily living”.

^ SFHOM H, Bro-Jeppesen J, Lip pert OK, Fiber L, Rancher M, Kjaergaard J, Has sager C (March 2014). “Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile”.

Journal of the American Medical Directors Association. ^ a b c d Fender TJ, Sports JA, Kennedy OF, Chen LM, German SM, Chan PS (2015-09-22).

“Alignment of Do-Not-Resuscitate Status With Patients' Likelihood of Favorable Neurological Survival After In-Hospital Cardiac Arrest”. ^ Poland LL, Scattered PA, Hanson JS, Strauss CE, Most D (January–March 2015).

“Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest”. HEATWAVE (BLS Training Site) CPR/AED & First Aid (Bellevue, NE).

^ Katz, Douglas I.; Pol yak, Meg; Coughlin, Daniel; Nichols, Feline; Roche, Alexis (2009-01-01). Laurels, Steven; Schiff, Nicholas D.; Owen, Adrian M.

“Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up”. ^ Pacino, Joseph T.; Katz, Douglas I.; Schiff, Nicholas D.; White, John; Ashman, Eric J.; Ashley, Stephen; Barbara, Richard; Hammond, Flora M.; Laurels, Steven (2018-08-08).

“Practice guideline update recommendations summary: Disorders of consciousness”. ^ The ranges given in the text above represent outcomes inside and outside of hospitals: In US hospitals a study of 12,500 survivors after CPR, 2000-2009, found: 1% more survivors of CPR were in comas than before CPR (3% before, 4% after), 5% more survivors were dependent on other people, and 5% more had moderate mental problems but were still independent.

[Chan PS, Sports JA, Armhole HM, Berg RA, Li Y, Samson C, Nallamothu BK (June 2012). “Supplement of A validated prediction tool for initial survivors of in-hospital cardiac arrest”.

Outside hospitals, half a percent more survivors were in comas after CPR (0.5% before, 1% after), 10% more survivors were dependent on other people because of mental problems, and 21% more had moderate mental problems which still let them stay independent. This study covered 419 survivors of CPR in Copenhagen in 2007-2011. Doi : 10.1016/j.resuscitation.2013.10.033 and works cited.

“Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest”. ^ a b Orioles A, Morrison WE, Romano JR, Shore PM, Has RD, Martinez AC, Berg RA, Nadkarni VM (December 2013).

^ Sandrine C, D'Arrive S, Callaway CW, Caribou A, Fragrance I, Vaccine FS, Antonelli M (November 2016). “The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis”.

^ Toll, Susan W.; Olszewski, Elizabeth; Schmidt, Terri A.; Five, Dana; Fromm, Erik K. (2012-01-04). “POST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences”.

“Implications of Including Do-Not-Resuscitate Status in Hospital Mortality Measures”. “Do not resuscitate does not mean do not treat: how palliative care and other modalities can help facilitate communication about goals of care in advanced illness”.

“Surgeons expect patients to buy-in to postoperative life support preoperative: results of a national survey”. ^ Marco CA, Moleskin E, Mann D, Holbrook MB, Service MR, Holyoke A, Hinting K, Ahmed A (March 2018).

“MEDICAL FUTILITY AND BENEFICIAL INTERVENTIONS: AN ALGORITHM TO AID CLINICIANS”. “FACTORS CONSIDERED IMPORTANT AT THE END OF LIFE BY PATIENTS, FAMILY, PHYSICIANS, AND OTHER CARE PROVIDERS” (PDF).

^ Range OF, Human J, Uris EM, Moss BR, Au DH (December 2013). “Preferences for death and dying among veterans with chronic obstructive pulmonary disease”.

Brunner-La Rocco HP, Rickenbacker P, Mozzarella S, Schindler R, Madder MT, Joker U, et al. (March 2012). “End-of-life preferences of elderly patients with chronic heart failure”.

“MYTHS AND FACTS ABOUT HEALTH CARE ADVANCE DIRECTIVES” (PDF). “Full Written Public Comment: Disability Related Concerns About POST”.

^ a b Jesus JE, Allen MB, Michael GE, Donning MW, Grossman SA, Hale CP, Bred AC, Brace A, O'Connor JR, Fisher J (July 2013). ^ “DNR Guidelines for Medical ID Wearers”.

^ Holt, Gregory E.; Sacramento, Bianca; Kept, Daniel; Goodman, Kenneth W. (2017-11-30). “An Unconscious Patient with a DNR Tattoo”.

^ Switz KM, Burke CM, Merge KM, Lanier WE (July 2014). “Ten common questions (and their answers) on medical futility”.

“Do-Not-Resuscitate Orders and Suicide Attempts: What Is the Moral Duty of the Physician?”. ^ a b Capone's paper, and the original by Jesus et al. say the patients were asked about CPR, but the questionnaire shows they were only asked whether they wanted intubation in various scenarios.

This is an example of doctors using the term resuscitation to cover other treatments than CPR. “Supplemental Appendix of Preferences for Resuscitation and Intubation...” (PDF).

“Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives”. ^ Escher M, Verdi no RJ, Ca plan AL, Kirkpatrick IN (August 2015).

“Defibrillator Deactivation against a Patient's Wishes: Perspectives of Electrophysiology Practitioners”. “CHARACTERISTICS AND OUTCOMES IN ADULT PATIENTS RECEIVING MECHANICAL VENTILATION” (PDF).

^ Rockford C, Fritz Z, George R, Court R, Grove A, Clarke B, Field R, Perkins GD (March 2015). “Do not attempt cardiopulmonary resuscitation (DNA CPR) orders: a systematic review of the barriers and facilitators of decision-making and implementation”.

^ Pollack AN, Eagerly D, McKenna K, Viber DA, et al. (American Academy of Orthopedic Surgeons) (2017). ^ Vincent JR, Van Wooden JP (December 2002).

^ a b Gibbs AJ, mayor AC, Fritz LB (June 2016). “Themes and variations: An exploratory international investigation into resuscitation decision-making”.

“Mideast med-school camp: divided by conflict, united by profession”. In hospitals in Jordan and Palestine, neither families nor social workers are allowed in the operating room to observe resuscitation, says Mohammad Yousef, a sixth-year medical student from Jordan.

“If it was within the law, I would always work to save a patient, even if they didn't want me to,” he says. “Nurses deny knowledge of 'do not resuscitate' order in patient's death”.

“Decisions relating to cardiopulmonary resuscitation: A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing” (PDF). “Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR): Integrated Adult Policy” (PDF).

The right to refuse or terminate medical treatment began evolving in 1976 with the case of Karen Ann Quinn v New Jersey (70NJ10, 355 A2d, 647 ). This spawned subsequent cases leading to the use of the DNR order.

Will they withhold resuscitation measures if my family asks them to? EMS personnel are taught to proceed with CPR when needed, unless they are absolutely certain that a qualified DNR advance directive exists for that patient.

A living will or health care proxy is NOT valid in the prehospital setting ^ “Do Not Resuscitate Orders”. ^ “Using resuscitation plans in end of life decisions” (PDF).

^ a b c Wen, Beaten; Lin, Ya-Chin; Cheng, Guofeng; Chou, Each; Wei, Chih-Hsin; Chen, Yunnan; Sun, Dialing (September 2013). “Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients”.

^ Penned, Sophie; Bonnier, Alain; Pantone, Silvia; Aubrey, Aegis (2012-12-03). “End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life”.

^ Penned, Sophie; Bonnier, Alain; Pantone, Silvia; Aubrey, Aegis (2012-12-03). “End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life”.

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