DNAR Orders: Problems, Causes, Solutions

In the Journal of General Internal Medicine, Jacqueline Yuen and colleagues review the problems with DNAR orders, the causes of those problems, and some solutions.

The problems:

• DNAR discussions occur too infrequently. 


• DNAR discussions occur too late.


• DNAR discussions fails to satisfy criteria for informed consent.


• Healthcare professions inappropriately extrapolate DNAR orders to other treatment decisions.

The causes of the problems:

• Medical culture that values the technological imperative.


• Inadequate hospital policies on DNAR discussion standards.


• Insufficient training of physicians in communication skills.


• Payment system that rewards volume and intensity of care.