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Nonstandard do-not-resuscitate orders

Holt, Gregory E.a,b; Goodman, Kenneth W.c; Olvey, Stephen E.d; Kett, Daniela,b

Current Opinion in Anesthesiology: April 2019 - Volume 32 - Issue 2 - p 179–183
doi: 10.1097/ACO.0000000000000690
ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle
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Purpose of review Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript.

Recent findings Studies show both providers and patients confuse the meaning and implication of DNR orders. In the United States, out-of-hospital DNR orders are legislated at the state level. Most states standardized out-of-hospital DNR orders so caregivers can immediately recognize and accept the order and act on its behalf. These out-of-hospital orders are complicated by the need to be printed on paper that does not always accompany the individual. Oregon created an online system whereby individuals recorded their end-of-life wishes that medical personnel can access with an Internet connection. This system improved communication of end-of-life wishes in patients who selected comfort care only.

Summary To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification.

aDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami

bDivision of Pulmonary and Critical Care, Miami VA Medical Center

cInstitute for Bioethics and Health Policy

dDepartments of Neurology/Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA

Correspondence to Gregory E. Holt, MD, PhD, University of Miami School of Medicine, Miami, FL 33136, USA. E-mail: gholt@miami.edu

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