Sahadevan S, Pang W S
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Singapore Med J. 1995 Jun;36(3):267-70.
Despite the fact that the pioneers of cardio-pulmonary resuscitation (CPR) designed the techniques for victims who were meant to be "salvable", currently CPR is largely applied to anyone who collapses, regardless of their underlying illness. However, the central fact is that CPR (and all its related complex and expensive technology) has a very low success rate (in terms of eventual hospital discharge) and the most important determinant of survival has always been the nature and stage of the underlying illnesses. All these bespeak of a need to have do-not-resuscitate (DNR) orders which will incorporate the pertinent medical, ethical, socio-cultural and legal components. In this discussion paper some guidelines for DNR orders relevant to Singapore are proposed, the main rationale of the guidelines are explained and some challenges and needed changes associated with its implementation are addressed.
尽管心肺复苏术（CPR）的先驱们设计这些技术是针对那些有望“获救”的受害者，但目前CPR在很大程度上适用于任何晕倒的人，无论其潜在疾病如何。然而，核心事实是CPR（及其所有相关的复杂且昂贵的技术）成功率非常低（以最终出院情况衡量），而生存的最重要决定因素一直是潜在疾病的性质和阶段。所有这些都表明需要制定“不要复苏”（DNR）医嘱，其中应纳入相关的医学、伦理、社会文化和法律要素。在这篇讨论文件中，提出了一些与新加坡相关的DNR医嘱指南，解释了这些指南的主要理由，并探讨了实施过程中相关的一些挑战和所需的变革。
