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October 2013

Not Practicing What We Preach

Author Affiliations
  • 1Children’s Mercy Bioethics Center, University of Missouri at Kansas City, Missouri
JAMA Pediatr. 2013;167(10):899-900. doi:10.1001/jamapediatrics.2013.2495

Physicians who care for critically ill children often do not know which babies are going to die. Even when experienced clinicians predict that a baby will die, they are often wrong.1 Clinicians must develop strategies to communicate with parents and to make decisions under conditions of significant prognostic uncertainty.

The study by Sanderson and colleagues2 shows that many physicians think that they do not do a good job at discussing do-not-resuscitate (DNR) orders. These physicians believe that DNR orders should be discussed early in the course of a child’s illness, before the child is acutely ill. They also believe that a DNR order should only mean that cardiopulmonary resuscitation should be withheld. A DNR order should not lead to other changes in treatment. Nevertheless, most of these clinicians discuss DNR orders with parents only when children are critically ill. Furthermore, they report that DNR orders often lead to the limitation or withdrawal of diagnostic and therapeutic interventions other than cardiopulmonary resuscitation. Clinicians apparently do not practice what they preach.

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