Journal of Critical and Intensive Care 0 , Vol 0 , Issue 0
Opinions of Chest Physicians about Do Not Resuscitate (DNR) Orders: Respect for Patient Autonomy or Medical Futility?
Esin Akgül Kalkan1, Arzu Mirici2
1Department of Forensic Medicine, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
2Department of Chest Diseases, Canakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
DOI : 10.5152/dcbybd.2018.1874

Summary

Objective: In this study it was aimed to investigate physicians’ knowledge, attitude and behavior related to cardiopulmonary resuscitation (CPR) and Do not resuscitate (DNR) order and factors associated with decisions to abide by the patient’s DNR orders were also evaluated.


Material and Methods
: An e-survey designed by the research team based on European Resuscitation Council Guidelines (ERC 2015), American Heart Association Guidelines (AHA2015) for resuscitation, and the relevant literature and legal regulations was administered to resident and specialist doctors in chest diseases. Descriptive data of number, percentage, mean and standard deviation are presented. The chi-square test was used for analysis of categorical data. Statistical significance was accepted as p<0.05.


Results
: The e-survey questions were answered by 376 physicians voluntarily. Of responders, 59.6% (n=224) were female and the mean age was 40.2±9.0 years.  About fifty seven percent of physicians reported that “if a doctor has decided medical futility, not performing CPR does not constitute an ethical debate”. Responses indicated 47.7% of physicians would abide DNR orders. A statistically significant difference was identified between “physicians’ decision not to perform CPR” and “abiding by the patient’s DNR orders” (p<0.05). There was also a statistically significant difference between “perceiving the DNR orders as euthanasia and thinking; abiding by this decision was a crime” and “abiding by patient’s DNR orders” (p<0.05)


Conclusion
: In this study, we observed that two main factors are foreground in the implementation of the DNR order. The first of these is the physician's opinion about medical futility of CPR, and the other is the lack of specific laws regarding DNR in Turkey. Defining specific legal regulations related to end-of-life decisions like DNR will aid in ensuring patient autonomy.