INTRODUCTION
The purpose of resuscitation is saving life, better health, relieving
pain, decreasing cobormidities and respecting the patient’s decisions,
rights and privacy (1). Additionally, regarding cardiopulmonary
resuscitation (CPR), the very important aim is to prevent death (2).
Although general rule being the urgent treatment for cardiac arrest,
there are several occasions where not performing CPR is more convenient.
In a study, it is shown that 54,9% of patients would not benefit from
CPR (3). CPR should be performed to patients whom will benefit the most.
Inevitable failure should not be accepted.
Do Not Attempt Resuscitation (DNAR) means do not perform resuscitation.
However, in various centers Allow Natural Death (AND) replaces DNAR (1).
DNAR definition should be well understood. Some physicians understand
DNAR just not performing CPR whereas some advocate not providing any
medical support to the patient. Not providing any medical support to the
patient is not accepted; neither in our county nor in the whole world.
Real DNAR decision only suggests not performing CPR. Next step should be
determining the person making the DNAR decision. DNAR decision should be
taken when the patient is having a cardiac arrest and needing CPR. This
decision is too much important to be made by a single person. In our
country, at CPR performing, ending and resuscitating, usually health
givers are managing the relations between the families showing a
paternalist approach. This paternalist approach is seriously criticized
in developed countries and is slowly replaced with ethical attitudes
involving the patient and his/her relatives (2). CPR decision should be
made not just in arrest occasions but also regarding the underlying
disease and the patient’s personal evaluation and current situation.
Another important issue is the variations in health givers’ religious
beliefs, occupations, ethnic features, and social status (3). In order
to maintain a standard management, clinicians, medical ethic
specialists, forensic medicine specialists, lawyers, sociologists,
religion experts and representatives of all different culture groups
should be involved to make a concrete decision (4).
Since DNAR term is not legitimately accepted in our country so it is not
performed. However, this does not change the number of patients whom
will not benefit from CPR performance. The ‘slow codes’ (showing
inefficient resuscitative efforts initiatively) occurring in such
occasions is not an appropriate method (1). This application is a moral
burden for the decision maker. It results in ethical bias among health
givers, misinterpretation and damages the saver-patient relationship
(1). Additionally, it also raises the CPR incidence of the country and
decreases the successful CPR rate (5). DNAR being fiercely debated among
the world and it is not generally discussed in our country, yet.
Our aim in this study is to evaluate the role of DNAR in emergency
theaters and to determine the practicability of DNAR term.