Talk:Do not resuscitate

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 30 August 2021 and 21 September 2021. Further details are available on the course page. Student editor(s): Figsaregreen2, Ciaranmurph, Etopn23. Peer reviewers: Thrombocytopenic.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 20:11, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Kmiller22, JVIDUYA, Tranhtruong, Kevindichosen1.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:38, 16 January 2022 (UTC)

US

The article as it stands is quite good, but it needs some international perspective, as it is completely US-based (which perfectly reasonable if the authors are American.) DNR (or NFR) orders are quite different in the UK, and I suppose in other parts of the world. An international persective would be useful. It might also be helpful to discuss the different perception between doctors and the public of the likely success of CPR and advanced life support. Anyone? Jellytussle 17:20, 6 December 2006 (UTC)

I thought so far the international sections were somewhat poorly supported with information. If others are willing to contribute more info then we can increase the international section.SpoticusKC 05:54, 30 June 2007 (UTC)

I'd like to see proper citation used through the article, especially for "In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders." Its not doubt that this occurs but rather, wanting to see the claim made concrete. GavinZac 14:41, 10 December 2006 (UTC)

As a licensed EMT-B, I can verify that we are instructed to honor DNR orders at the scene unless any family member present asks us to intervene, in which case we are required to do so and take the patient to the ER. A DNR can only be honoured against family wishes by a doctor. --DesiArcy (talk) 23:29, 7 August 2009 (UTC)

In the UK, can it ever be legal to put a DNR on someone's file against their explicit will, or without their consent if they are able to consent? The comments of the Department of Health spokesperson in this article suggest that. --88.73.34.114 (talk) 19:39, 27 August 2011 (UTC)

DNR Tattoos

Does anyone think there should be a paragraph or section included in this article about DNR tattoos?Peaceoutside 22:52, 16 July 2007 (UTC)

I have seen two different photographs of DNR tattoos but never one in person. I dont think it is yet a large enough culture phenomenon and the legality of such is not clear. SpoticusKC 03:51, 17 July 2007 (UTC)

Maybe you have your wish now :)

http://www.nejm.org/doi/full/10.1056/NEJMc1713344 

Chickpecking (talk) 08:32, 7 December 2017 (UTC)

Accuracy of CPR

This article desperately needs to be rewritten by someone (preferably a physician) who works in critical care. I'm an American medical student and in my very brief experience with DNR orders, the way they are actually described to patients and the effect they have on care is pretty poorly captured by this article.

Also, I'm not sure where the 10% success figure is coming from, but whether or not ACLS is successful is highly context dependent. A brief websearch reveals this: http://emj.bmj.com/cgi/content/abstract/21/3/370 which makes me suspect that the 10% figure is a low-ball figure for the success rate of recusitation during non-hospital encounters. It isn't very informative to rattle off (uncited) figures without giving some idea as to what the population those figures are derived from is. My suspicion is that in-hospital resuscitation has a much higher success rate than reported in this article. 70.5.13.102 05:45, 2 September 2007 (UTC)GMM

Most of the talk of 'success of CPR' is better suited for the CPR page on wikipedia, although it is relevant to deciding on whether or not to choose a DNR order over a CPR order. The CPR page has relevant citations that would be useful to put on this page. To the medical student, you should take a stab at writing more to the article and others will reinfe and edit where needed. Most of the medical pages here are quite inadequate.SpoticusKC 02:06, 8 September 2007 (UTC)

It is impossible to attach a figure to THE survival rate of CPR. Outcomes vary extremely widely according to demographics and time and place. Read [1] for more info on the subject. Survival rates are particularly low for those over 60 and with asystoly. Intermediate outcomes are in the order of 10% overall, and much lower for those mentioned above. The immediate overall outcome of an in hospital resus event is in the order of 30% according to the article. I wonder if that figure is not artificially high due to some local practice. I haven't read thoroughly, but it seems this takes into account EVERY call made to the resus team. Most of those will be for cases without actual cardiac arrest anyways. Ft. Jack Hackett 12:10, 16 September 2007 (UTC)

WikiProject class rating

This article was automatically assessed because at least one WikiProject had rated the article as start, and the rating on other projects was brought up to start class. BetacommandBot 03:56, 10 November 2007 (UTC)

Accuracy of terms

Advance directives and DNAR orders are quite different as you can read on Decisions Relating to Cardiopulmonary Resuscitation. A Joint Statement by the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing” 2007. This article should be reviewed in order to make this more clear. —Preceding unsigned comment added by 195.23.102.126 (talk) 12:30, 16 February 2011 (UTC)

Ethical Issues

I think ethical issues around this topic could be fleshed out more. Having dealt with some professionally, I will try to work on this. What do you do in the case of a pt who is a DNR but tried to commit suicide? Also there is unfortunate confusion between comfort care and DNR even among health care providers. What ethical issues are involved when you decide on DNR but have an implantable cardioverter-defibrillator- there is debate about turning these off in certain situations. I have seen lackadaisical medicine for DNR patients but for me I am if anything more careful in DNR patients so they do not cross the point of "no return" (needing a vent or cardiac intervention).Chickpecking (talk) 23:30, 13 December 2015 (UTC)

This is a great point, I think other points to consider would be disagreements within a medical team as to whether or not DNR should be ordered, differences in opinion between the patient and their relatives, and communication about DNR between medical providers and their families. Sophiakalei (talk) 01:32, 13 September 2022 (UTC)

Agree with all of the above points. One area in particular that I think could be fleshed out more is the section regarding ethnic/racial disparities in rates of adoption for DNR. Numerous studies have found that there are inaccurate beliefs regarding resuscitation and the expected outcomes among the general public, which is likely even more prevalent in disadvantaged communities. Improving education around DNR in these populations through media, community interventions, and other avenues may be a way to address these disparities. Christophermlee (talk) 23:05, 15 September 2022 (UTC)

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Netherlands

The Netherlands has the Niet-Reanimeringsverklaring, or Non-Resuscitation Statement. In 2007, the policy came into effect. It was authorized by the NVVE.

The contribution above was added to the article page by @82.72.90.35: at 2017-11-19T16:00:36 with the edit comment:

The Dutch also have the DNR form, called the Niet-Reanimeringsverklaring. I learned about it in my Dutch Language Studies.)

 Declined  Spintendo  ᔦᔭ  20:38, 6 December 2017 (UTC)

Foundations 2 2019, Group 5b goals

Hello, we are a group of 4 students in the UCSF School of Pharmacy Class of 2021T and our goals for editing this article include:

• add in requirements for other countries?
• confirm US requirements
• add forms of DNR including medical bracelets, use of DNR tattoos

Tranhtruong (talk) 21:43, 29 July 2019 (UTC)

Kevindichosen1 (talk) 21:46, 1 August 2019 (UTC)

I moved your signature to the end of the text. Health policy (talk) 03:31, 31 July 2019 (UTC)

US state laws generally require CPR unless there is a doctor's signed order not to or a state-approved bracelet. Even if the tattoo included a doctor's signature, most medics might have doubts about honoring it, since the tattoo artist actually put in the signature, not the doctor. The tattoo could have a QR code or web address holding a pdf of the doctor's signature, but medics are likely to start CPR immediately and only if they have time later go to the website and perhaps stop CPR. It seems far more useful to have the state-approved bracelet, or have the signed order on a folded piece of paper taped to the driver's license. The 2nd medic looks at the driver's license soon after the first one starts CPR. They need ID for billing and reporting. Numbersinstitute (talk) 20:42, 31 July 2019 (UTC)

References

Peer Review of Team 5b by Team 5a

Do the group’s edits substantially improve the article as described in the Wikipedia peer review “Guiding framework”?

• Yes, this group has added the topics of DNR medical jewelry and DNR tattoos to the article, and they were not previously present. They have also expanded on DNR in Taiwan and Japan.

Has the group achieved its overall goals for improvement?

• Goal 1: Requirements for other countries. This goal was fulfilled. They added the requirements for Japan and Taiwan.
  
• Goal 2: Confirm U.S. requirements. We are unsure if this goal was fulfilled. The group did not edit any text regarding U.S. requirements. If the group did indeed confirm the U.S. requirements with the current article text, they can update their Talk section stating that this was done.
  
• Goal 3: add forms of DNR including medical bracelets, use of DNR tattoos. This goal was fulfilled. They added a section on DNR tattoos and medical bracelets.
  

Does the draft submission reflect a neutral point of view? If not, specify…

• The added information for medical jewelry and DNR tattoos provides a neutral point of view. Additionally, the information about the legality of DNR in Taiwan and Japan are fairly factual and devoid of any positive or negative connotations. Christinewmin (talk) 16:21, 6 August 2019 (UTC)
  

Are the points included verifiable with cited secondary sources that are freely available? If not, specify…

• Team 5b added 7 new references to this article. With the following exceptions, references seem to be appropriate and support the added content.
  

1. References 48 and 49 are not from a secondary source.
   
2. I was unable to find the information cited by Reference 84 in the linked article. I did, however, find similar information in Reference 85 (“Insights into Chinese perspective on DNR orders…”), so the citation might just be misplaced. Mlomanto (talk) 16:54, 6 August 2019 (UTC)
   

Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

• The group formats their citations and additional information properly, well done. DanielPerez144 (talk) 17:02, 6 August 2019 (UTC)

Is there any evidence of plagiarism or copyright violation? If yes, specify…

• I found a few phrases that were similar to phrases found in other pre-existing articles. Hopefully these are just coincidences, but I would recommend rewording these phrases to prevent any potential plagiarism.
• “Laws vary from state to state regarding what constitutes a valid DNR” was found in article https://www.ems1.com/paramedic-chief/articles/372711048-DNR-tattoos-Are-they-legal-and-is-EMS-bound-to-comply/
• “In some cases, people have even received the DNR tattoo on a dare or while inebriated.” similar to a phrase found in an article on verywellhealth entitled "Can Paramedics and Doctors Honor Medical Tattoos?". I cannot link it directly as it is a wikipedia blacklisted website. Kshim054 (talk) 21:39, 5 August 2019 (UTC)

• Sentences mentioned above have been revised. Thanks!

Tranhtruong (talk) 16:40, 6 August 2019 (UTC)

UCSF Group 3d agenda

Tentative plan for UCSF editing: Expand on patient values, medical jewelry, DNR tattoos, usage by country (New Zealand/more countries in the middle east), repercussions of violating a DNR order, and potentially add more controversial court cases to supplement that section. Etopn23 (talk) 17:07, 30 August 2021 (UTC)

Unable to find much information on the medical jewelry/DNR Tats so changed topic to legal precedent behind the right to refuse medical interventions under an appropriate subheading as I feel it's relevant Etopn23 (talk) 22:13, 12 September 2021 (UTC)

Review of DNR violations section

Author provided clear explanation about violations of DNR and how they can differ depending on state laws.

It would help to understand what the suspension of DNR process is like and maybe in general what conditions must be met in order for this to occur.

All other components clear and good citations.

Legal precedents

Interesting cases. No revisions needed.

DNR in Other Countries

Well written section, no edits needed. Great to add a global perspective on DNR and other cultural approaches to end-of-life care.

Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 August 2022 and 20 September 2022. Further details are available on the course page. Student editor(s): Ntp93, WikEWombat, Samsonite23 (article contribs). Peer reviewers: Christophermlee, Seyvonneip.

— Assignment last updated by Christophermlee (talk) 23:33, 16 September 2022 (UTC)

No code

Hey,can someone with a wiki data account replace the citation needed on the image about no code with the second citation? Coolman2932 (talk) 20:44, 12 September 2022 (UTC)

MEDI6100 WikiProject Task 2023

We are reviewing this article as part of a university assignment, and have identified the following areas for improvement:

- Clarify use of the 222/2222 DNR code in the UK

- Insert citation for "no code" usage under the DNR image

- Link medical futility term to sister page

- Improve citations for medical jewellery application and usage in the relevant section WillP92 (talk) 03:57, 27 January 2023 (UTC)

I have edited the no code citation to include the medline citation that is quoted later in the article again and added it to the image where it previously said "citation needed" Preetiraghwani (talk) 04:06, 27 January 2023 (UTC)

Edited citation needed in caption next to "no code" under image to correspond to references 4 and 5 respectively. Preetiraghwani (talk) 07:33, 27 January 2023 (UTC)

Removed reference to the old practice of 222 coding, updated the language and links to reflect the contemporary recommendations. WillP92 (talk) 02:54, 29 January 2023 (UTC)

Unexplained acronym

Suddenly under "Less care for DNR patients" the acronym 'DNAPR' is used without explanation (first sentence). The paper to which reference is then made in relation to it makes no reference to either 'DNAPR' or to 'DNACPR', but refers, like the rest of the article, only to 'DNR'.

So it seems as if DNAPR is simply a mis-type for DNR, in which case it could be corrected without further ado.

If on the other hand for some reason this 'DNAPR' is meant to be 'DNACPR' then it could usefully be corrected to that and the full expansion given (Do Not Attempt CardioPulmonary Resuscitation), but a little further explanatory text would be required to make clear why this different terminology is suddenly being introduced.Buyani Nyoni (talk) 07:20, 23 February 2024 (UTC)

I should add that this is the sole use of the acronym 'DNAPR' in the article.Buyani Nyoni (talk) 07:24, 23 February 2024 (UTC)