Do-not-resuscitate orders and withheld or withdrawn treatment.

Advances in medicine have brought immense possibilities in therapy but at a price including tremendous financial costs and also protracted human suffering. Cardiopulmonary resuscitation (CPR) is an emergency procedure in patients with cardiopulmonary arrest. Out-come of the CPR depends upon the character and severity of the afflicting disease, upon the patient's condition before cardiopulmonary arrest and upon the response to therapy. CPR is instituted by emergency medical technicians automatically even in terminal condition of patients. Various models for prognostic prediction may confirm early decision about relevance of continuing treatment and writing a "DO-NOT-RESUSCITATE" order or withdrawing treatment. Numerous studies pointed out two exceptions, when CPR is not started and when the aggressive therapy is withdrawn-DNR order is written in the patient's medical record: 1. on the basis of autonomy the patient may not consent with CPR in advance or when he is incompetent, the family or surrogate decide to withdraw treatment: 2. physician is not obliged to provide diagnostic or therapeutical interventions (not even when requested by the family), when these acts are futile. The meaning of futility may be understood in a different way, but always the ethical principles must be considered: beneficence, maleficence, social justice and autonomy of the patient. In burn medicine, there are different factors encouraging the DNR orders, withheld and withdrawn treatment. This dilemma might be decided only by an interdisciplinary conference.