My research investigates the experiences of US and UK doctors regarding autonomy and satisfaction in DNR decision-making at the end of life. It hopes to explore the prioritization of autonomy versus non-maleficence in decisions surrounding the “Do Not Resuscitate” (DNR) status.
In the United States, decisions to pursue a DNR order in the inpatient setting must be agreed upon with the patient or surrogate. In the United Kingdom, CPR can be withheld without discussion with the patient or surrogate if it is deemed medically appropriate. Most American hospitals have policies, which typically give the physician the authority to discontinue life-sustaining treatments if they are non-beneficial. Actual practice does not reflect this. Physicians are often unwilling to exert this power given concerns that they would not be institutionally supported in the decision. De facto practices bind physicians to administering non-beneficial treatments and offering CPR regardless of clinical situation and de jure policies. I am exploring this through semi-structured interviews of doctors in England and the United States.
The DNR decision reflects a complex interplay between the ethical, personal, and clinical beliefs of both doctor and patient. Deeper insight into the sociologic underpinnings of these interactions will help clinicians better understand how these decisions are made and how the decision making process can be facilitated.