Diamond Jamie, Gidwani Umesh, Rhodes Rosamond
473 Columbus Ave., Apt 2C, New York, New York 10024 USA.
Icahn School of Medicine, Department of Cardiology, 1 Gustave Levy Place, Box 1030, New York, New York 10029 USA.
J Clin Ethics. 2017 Summer;28(2):159-162.
Do-not-resuscitate (DNR) orders are typically signed by physicians in conjunction with patients or their surrogate decision makers in order to instruct healthcare providers not to perform cardiopulmonary resuscitation (CPR). Both the medical literature and CPR guidelines fail to address when it is appropriate for physicians to sign DNR orders without any knowledge of a patient's wishes. We explore the ethical issues surrounding instituting a two-physician DNR for a dying patient with multiple comorbidities and no medical record on file, no advance directives, and no surrogate decision maker. Through this case we also highlight the issues of poor prognostication and the reversal of a DNR in such circumstances.
不要复苏（DNR）医嘱通常由医生与患者或其替代决策者共同签署，以指示医疗保健提供者不进行心肺复苏（CPR）。医学文献和心肺复苏指南均未涉及医生在不了解患者意愿的情况下何时适合签署DNR医嘱。我们探讨了为一名患有多种合并症、没有病历存档、没有预先指示且没有替代决策者的临终患者制定双医生DNR医嘱所涉及的伦理问题。通过这个案例，我们还强调了预后不良以及在这种情况下撤销DNR医嘱的问题。
