Not for resuscitation: more harm than good?

Advance directives such as do not resuscitation orders are becoming more common place in Irish Hospitals. A questionnaire was completed by all 44 interns working in St James' Hospital in January 2010 and by 49/50 Senior House Officers in June 2010.3/44 of interns (6%) and 5/49 (10%) SHO believe that there is no difference between palliative patients and NFR patients. 41/44 interns (93%) and 40/49 of SHOs (81%) believe that attitudes of treating staff change once a patient is listed as NFR. 14/44 of Interns (32%) and 15/49 SHOs (31%) think that nursing staff are reluctant to request a review when these patients become unwell. They were asked if someone listed as NFR became unwell, what would be an appropriate intervention using a grading system. Interns and SHOs appeared to be reluctant to make basic interventions such as blood tests, blood cultures or even oral antibiotics in this sub group of patients. This questionnaire demonstrates that NFR patients are potentially treated differently and possibly under treated by Junior Doctors. The question remains how to balance the best interests of the patient. If NFR status results in under treatment does it cause more harm than good.