Do-Not-Resuscitate Orders Tougher When It's Not Patient's Call
Study found surrogate decision-making causes delay, boosts costs
TUESDAY, July 19, 2011 (HealthDay News) -- A new study finds that it takes longer to create do-not-resuscitate orders when someone other than the patient is making the decision, even though many of the patients in these cases are sicker than patients able to make their own decisions.
When patients are incapable of deciding what should happen if their heart stops beating -- possibly because they are unconscious, suffering from dementia or unable to speak -- a spouse, relative or other loved one usually has to make the difficult decision whether to sign an order to let them die naturally or allow extreme measures to keep them alive. In health care, this is part of surrogate decision-making.
"Surrogate decision-making is not just more challenging for everyone, it actually affects important care processes in the hospital -- in this case, code orders," study author Dr. Alexia Torke, an assistant professor of medicine at the Indiana School of Medicine, said in a university news release.
Unless patients or their surrogates have do-not-resuscitate orders, hospital patients are generally assumed to be eligible for full resuscitation if they are dying. A do-not-resuscitate order allows doctors and nurses to bypass extreme measures to keep a dying person alive -- such as shocking them out of cardiac arrest or putting them on artificial ventilation and/or feeding tubes indefinitely -- and instead to allow them to be comfortable and die naturally.
In the study, researchers examined the records of 668 people aged 65 and older in an urban public hospital. Surrogates, such as relatives, made decisions about resuscitation almost 60 percent of the time.
It took longer for decisions to be made when the surrogates were involved, potentially boosting costs. The researchers hope for more research to determine if supporting the surrogates will shorten the process and help in areas like cost and length of stay in the hospital.
"The delay in DNR orders may be due to the more complex ethical and communication issues involved in surrogate decision-making compared to patient decision-making," Torke explained. "For a variety of reasons, including not being sure of what the patient would want, surrogates may have difficulty making the DNR decision."
The study, funded by the U.S. National Institute on Aging, appears in the July issue of the Journal of the American Geriatrics Society.
The University of Washington has more on do-not-resuscitate orders.