Report on Bioethics: Advance Care Directives - Law Reform ...

assist either health care professionals or patients on the circumstances in whicha DNR order should be put in place.3.29 In the Consultation Paper, the Commission invited submissions onthe status of DNR orders. 41 Submissions received made it clear that ambiguitysurrounding DNR orders have created real difficulties in health care practice.Among the problems identified in the Irish studies were that decisions on DNRorders were taken at too junior a level, that the patient was not included in thedecision-making process and that there was low quality of the DNRdocumentation. 42 It was also noted that consultants generally favoureddiscussing the order with the family of the patient but that they felt that adiscussion with the patient and the family was in line with best practice. 43 Thestudy found that patients who had a DNR order written on their chart had amean age of 76 years, 44 thus indicating that older people are much more likelyto be subject to a DNR order. Another study also found that doctors are lesscomfortable discussing DNR orders with patients than other forms of medicaltreatment, 45 with 43% of consultants almost never discussing resuscitationpreferences in advance with a patient. 463.30 As the Commission has already noted, a person cannot demandspecific forms of treatment, so that a doctor is under no obligation to administerCPR if he or she does not think that it is medically appropriate. The Commissionnotes that, on the basis of the Irish studies mentioned, a DNR decision can be,and often is, taken by a doctor without consulting the patient concerned. TheCommission considers that decisions about resuscitation should, in general, bemade in advance and form a part of a patient‘s care plan. This ensures that,where possible, the patient is involved in the decision making process. If the414243444546Law Reform Commission Consultation Paper Bioethics: Advance Care Directives(LRC CP 51-2008), at paragraph 1.47.Robinson and O‘Neill ―Communication and Documentation of Do-Not-Attempt-Resuscitation Orders in an Irish Teaching Hospital‖ (2005) 11(2) Medico LegalJournal of Ireland 60, at 60-61.Ibid, at 61.Ibid, at 60.Sulmasy, Sood and Ury ―Physicians Confidence in Discussing Do NotResuscitate Orders with Patients and Surrogates‖ (2008) 34 Journal of MedicalEthics 96, at 99.Fennell, Butler, Saaidin and Sheikh ―Dissatisfaction with Do Not AttemptResuscitation Orders: A Nationwide Study of Irish Consultant PhysicianPractices‖ (2006) 99(7) Irish Medical Journal 208, at 208.64