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Do not resuscitate
  1. ANTHONY J HANDLEY, Past Chairman Resuscitation Council (UK)
  1. Department of Cardiology
  2. Colchester General Hospital
  3. Turner Road
  4. Colchester CO4 5JL, UK

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Last year the Resuscitation Council (UK) together with the British Medical Association and the Royal College of Nursing updated their statement “Decisions relating to cardiopulmonary resuscitation”. This short document should be read by all healthcare professionals whose practice may involve “do not resuscitate” (DNR) decisions. It is designed to be a framework on which hospital and other trusts may build their own more detailed guidelines.

The advice contained within the document seems simple enough. There are three situations in which a DNR order is appropriate: if cardiopulmonary resuscitation (CPR) is unlikely to be effective; if it is known that the patient does not wish to receive CPR; and if successful CPR would not result in a length, or more importantly a quality, of life which would be in the patient's best interest.

Surely few would disagree? Yet there has been considerable misunderstanding, particularly on the part of the public, and some reluctance by the medical profession to follow these guiding principles.

Maintaining other treatment

It must be fully understood by all concerned—patients, doctors, nurses, and relatives—that DNR orders apply only to the decision whether or not to initiate CPR in the event of respiratory or cardiac arrest. Unfortunately, there is, at least in the USA, evidence that this principle is …

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