In the Journal of General Internal Medicine, Jacqueline Yuen and colleagues review the problems with DNAR orders, the causes of those problems, and some solutions.
The problems:
- DNAR discussions occur too infrequently.
- DNAR discussions occur too late.
- DNAR discussions fails to satisfy criteria for informed consent.
- Healthcare professions inappropriately extrapolate DNAR orders to other treatment decisions.
The causes of the problems:
- Medical culture that values the technological imperative.
- Inadequate hospital policies on DNAR discussion standards.
- Insufficient training of physicians in communication skills.
- Payment system that rewards volume and intensity of care.
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