Practitioners' First Choice
Practitioners' First Choice

Should DNAR (Do Not Attempt Resuscitation) be a patient or clinical team choice?

Dr. Uche:

A timely question given the Damar Hamlin story. This decision belongs to the clinical team.

Ask me this question 13 years ago, before I’m ever at medical school or a doctor and I would have answered, rather bewildered, that it belongs to the patient or their Attorney…like who else should have the right to decide that? However, fast forward 13 years and having been in a dozen real life resuscitation events, I now understand that it’s almost an impossible decision for a patient to make in full knowledge. The act of resuscitation can be traumatic (cracked ribs), undignified (multiple people creating access points over the body), and has a less than 50% success rate, even within a hospital setting.

Despite the emotional and sentimental quagmire that issuing a Do Not Resuscitate Certificate can evoke, it’s truly difficult for patients or family to objectively understand that it is not always appropriate to subject a person to CPR. Not to mention, while this may be hard for many to hear (and I’d be the same if I were faced with this), if a patient is requiring CPR then they are clinically already dead! If that person were chronically ill and hospitalised then it suggests that all the interventions carried out during their life were ineffective up to that point. 


So doctors get to play god to decide who gets to life-saving treatment? 1) absolutely not 2) if you agree, how do you determine that?

There is NOOOOOO way that DNAR should be put in the hands of clinicians who could have ableist, racist, sexist or ageist bias that could impact their discretion as to who gets to be saved or not. Healthcare workers are service providers who are there to preserve life, reduce incidence of morbidity and maintain health. To arbitrarily decide who should get life-saving treatment or not is to put too much authority in the hands of very fallible humans.

Doctors should always aim for a “do no harm” approach to healthcare and that includes doing their damn best to resuscitate anyone who could possibly be saved with a medical intervention. To decide when and how to do so on a case by case basis will lead to issues of discrimination in death which is one place that should remain sacred and untainted by human bias.  

*Disclaimer: All opinions expressed on this platform are those of the individuals and not representative of any particular institution. This is not to be taken as medical advice.


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