Unilateral pediatric "do not attempt resuscitation" orders: the pros, the cons, and a proposed approach

Title

Unilateral pediatric "do not attempt resuscitation" orders: the pros, the cons, and a proposed approach

Creator

Mercurio MR; Murray PD; Gross I

Publisher

Pediatrics

Date

2014

Subject

Child; Female; Humans; infant; Male; Parental Consent; Pediatrics; Prognosis; Resuscitation Orders; Ethics; Medical; quality of life; Newborn; Extremely Premature

Description

A unilateral do not attempt resuscitation (DNAR) order is written by a physician without permission or assent from the patient or the patient's surrogate decision-maker. Potential justifications for the use of DNAR orders in pediatrics include the belief that attempted resuscitation offers no benefit to the patient or that the burdens would far outweigh the potential benefits. Another consideration is the patient's right to mercy, not to be made to undergo potentially painful interventions very unlikely to benefit the patient, and the physician's parallel obligation not to perform such interventions. Unilateral DNAR orders might be motivated in part by the moral distress caregivers sometimes experience when feeling forced by parents to participate in interventions that they believe are useless or cruel. Furthermore, some physicians believe that making these decisions without parental approval could spare parents needless additional emotional pain or a sense of guilt from making such a decision, particularly when imminent death is unavoidable. There are, however, several risks inherent in unilateral DNAR orders, such as overestimating one's ability to prognosticate or giving undue weight to the physician's values over those of parents, particularly with regard to predicted disability and quality of life. The law on the question of unilateral DNAR varies among states, and readers are encouraged to learn the law where they practice. Arguments in favor of, and opposed to, the use of unilateral DNAR orders are presented. In some settings, particularly when death is imminent regardless of whether resuscitation is attempted, unilateral DNAR orders should be viewed as an ethically permissible approach.
2014-02

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

S37-43

Volume

133 Suppl 1

Citation

Mercurio MR; Murray PD; Gross I, “Unilateral pediatric "do not attempt resuscitation" orders: the pros, the cons, and a proposed approach,” Pediatric Palliative Care Library, accessed September 24, 2021, https://pedpalascnetlibrary.omeka.net/items/show/14891.

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