Biomaterial Database

Deciding not to resuscitate in Dutch hospitals. 1993

J J van Delden, and P J van der Maas, and L Pijnenborg, and C W Looman

Department of Public Health and Social Medicine, Erasmus University, Rotterdam, The Netherlands.

The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable.

UI	MeSH Term	Description	Entries
D008511	Medicine	The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health.	Insurance Medicine,Medical Specialities,Medical Specialties,Medical Specialty,Specialities, Medical,Specialties, Medical,Specialty, Medical,Insurance Medicines,Medical Speciality,Medicine, Insurance,Medicines, Insurance,Speciality, Medical
D009426	Netherlands	Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, and Sint Maarten, formerly included in the NETHERLANDS ANTILLES.	Holland,Kingdom of the Netherlands
D010358	Patient Participation	Patient involvement in the decision-making process in matters pertaining to health.	Patient Activation,Patient Empowerment,Patient Engagement,Patient Involvement,Patient Participation Rates,Activation, Patient,Empowerment, Patient,Engagement, Patient,Involvement, Patient,Participation Rate, Patient,Participation Rates, Patient,Participation, Patient,Patient Participation Rate
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D011795	Surveys and Questionnaires	Collections of data obtained from voluntary subjects. The information usually takes the form of answers to questions, or suggestions.	Community Survey,Nonrespondent,Questionnaire,Questionnaires,Respondent,Survey,Survey Method,Survey Methods,Surveys,Baseline Survey,Community Surveys,Methodology, Survey,Nonrespondents,Questionnaire Design,Randomized Response Technique,Repeated Rounds of Survey,Respondents,Survey Methodology,Baseline Surveys,Design, Questionnaire,Designs, Questionnaire,Methods, Survey,Questionnaire Designs,Questionnaires and Surveys,Randomized Response Techniques,Response Technique, Randomized,Response Techniques, Randomized,Survey, Baseline,Survey, Community,Surveys, Baseline,Surveys, Community,Techniques, Randomized Response
D003644	Death Certificates	Official records of individual deaths including the cause of death certified by a physician, and any other required identifying information.	Death Records,Certificate, Death,Certificates, Death,Death Certificate,Death Record,Record, Death,Records, Death
D005190	Family	A social group consisting of parents or parent substitutes and children.	Family Life Cycles,Family Members,Family Life Cycle,Family Research,Filiation,Kinship Networks,Relatives,Families,Family Member,Kinship Network,Life Cycle, Family,Life Cycles, Family,Network, Kinship,Networks, Kinship,Research, Family
D006761	Hospitals	Institutions with an organized medical staff which provide medical care to patients.	Hospital
D012945	Social Values	Abstract standards or empirical variables in social life which are believed to be important and/or desirable.	Value Orientation,Values, Social,Value Orientations
D013038	Specialization	An occupation limited in scope to a subsection of a broader field.	Specialism,Specialists,Specialist