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August 14, 1991

Questions About DNR Orders

Author Affiliations

University of Arizona Health Sciences Center Tucson

University of Arizona Health Sciences Center Tucson

JAMA. 1991;266(6):794-795. doi:10.1001/jama.1991.03470060056015

To the Editor.  — In his editorial responding to the AMA "Guidelines for the Appropriate Use of Do-Not-Resuscitate [DNR] Orders,"1 Lo2 suggests a plan for discussing DNR orders with hospitalized patients and notes that DNR decisions should be made openly. We concur with Lo's suggestions, but recommend that a further step be explicitly addressed to enhance the quality of these discussions and the decisionmaking process. Physicians should investigate and acknowledge the meanings that patients and families hold both about resuscitative attempts and a good death.Just as physicians bring to discussions about DNR orders perceptions that are drawn from individual experience and information derived from medical literature, patients also maintain images of resuscitation derived from both life experience and the media. Failure to recognize these images, expectations of health providers, and cultural dimensions of death make discussions of attempted resuscitation difficult.3 While physicians are talking about the mechanistic