Are physicians on the same page about do-not-resuscitate? To examine individual physicians’ influence on do-not-resuscitate decision-making: a retrospective and observational study

BMC Medical Ethics. 2019;20(1):1-13 DOI 10.1186/s12910-019-0429-z


Journal Homepage

Journal Title: BMC Medical Ethics

ISSN: 1472-6939 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Medicine (General): Medical philosophy. Medical ethics

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Yen-Yuan Chen (Department of Medical Education, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, National Taiwan University Hospital)

Melany Su (New York University School of Medicine)

Shu-Chien Huang (Department of Surgery, National Taiwan University Hospital)

Tzong-Shinn Chu (Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine)

Ming-Tsan Lin (Department of Surgery, National Taiwan University College of Medicine)

Yu-Chun Chiu (Department of Medical Education, National Taiwan University Hospital)

Kuan-Han Lin (Department of Healthcare Administration, Asia University)


Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 25 weeks


Abstract | Full Text

Abstract Background Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. Methods This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. Results We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. Conclusion Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.