Institutional members access full text with Ovid®

Share this article on:

Partial do-not-resuscitate orders: A hazard to patient safety and clinical outcomes?*

Sanders, Alan PhD; Schepp, Melissa MD, FAAHPM; Baird, Marianne RN, MN, PCCN

doi: 10.1097/CCM.0b013e3181feb8f6
Feature Articles

Background: Patients and families commonly discuss end-of-life decisions with clinicians to create a treatment plan based on patient wishes. In some instances, respect for patient autonomy in making choices may create the potential for patient harm. Medical treatments are often performed in groupings in order to work effectively. When such combinations are separated as a result of patient or surrogate choices, critical elements of life- saving care may be omitted, and the patient may receive nonbeneficial or harmful treatment. A partial do-not-resuscitate order may serve as an example.

Literature Review and Discussion: The limited literature available regarding partial do-not-resuscitate order(s) suggests the practice is clinically and ethically problematic. Not much is known about the prevalence of these orders, but some clinicians believe they are a growing phenomenon. Medical and bioethics organizations have produced guidelines and recommendations on the use of full do-not-resuscitate order(s) with little mention of partial do-not-resuscitate order(s). Partial do-not-resuscitate order(s) are designed based on the patient's anticipated need for resuscitation and are intended to manage dying in a tolerable manner based on what the decision maker believes is “best.” Through an analysis of the medical literature, we propose that a partial do-not-resuscitate order contradicts this “best” management intention because it is impossible for the decision maker, or care providers, to anticipate all possible prearrest and arrest situations. We propose that a partial do-not-resuscitate order highlights larger problems: 1) a misunderstanding of the meaning and scope of a do-not-resuscitate order and 2) a need for discussions around goals of care.

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

Center for Ethics (AS), Saint Joseph's Hospital, Atlanta, GA; Catholic Health East (AS), Atlanta, GA; Palliative Care (MS), Saint Joseph's Hospital, Atlanta, GA; and Center for Nursing Excellence (MB), Saint Joseph's Hospital, Atlanta, GA.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail:

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins